Provider Demographics
NPI:1134416241
Name:NIELSEN, LEIGHA MISHELLE (OD)
Entity type:Individual
Prefix:DR
First Name:LEIGHA
Middle Name:MISHELLE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-0918
Mailing Address - Country:US
Mailing Address - Phone:210-590-8284
Mailing Address - Fax:210-590-2694
Practice Address - Street 1:17460 IH 35 N
Practice Address - Street 2:STE. 412
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1243
Practice Address - Country:US
Practice Address - Phone:210-590-2482
Practice Address - Fax:210-590-2694
Is Sole Proprietor?:No
Enumeration Date:2011-07-09
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7776T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist