Provider Demographics
NPI:1891295333
Name:LAPORTE, LEANNE (OD)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:LAPORTE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MONTGOMERY MALL
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-3903
Mailing Address - Country:US
Mailing Address - Phone:215-361-2400
Mailing Address - Fax:215-361-0917
Practice Address - Street 1:2329 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1003
Practice Address - Country:US
Practice Address - Phone:215-332-7228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003383152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist