Provider Demographics
NPI:1205915451
Name:GOSLAK, LEANN (OD)
Entity type:Individual
Prefix:DR
First Name:LEANN
Middle Name:
Last Name:GOSLAK
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 1:265 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4806
Mailing Address - Country:US
Mailing Address - Phone:330-726-6302
Mailing Address - Fax:330-726-0025
Practice Address - Street 1:8113 HUNTING VALLEY DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-8120
Practice Address - Country:US
Practice Address - Phone:412-480-0275
Practice Address - Fax:330-726-0025
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI5-0000003152W00000X
PAOEG00026152W00000X
IN18004462A152W00000X
WI3716-35152W00000X
INTH0006321152W00000X
NE1563152W00000X
MDDA1512152W00000X
OHOH 4893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U79066Medicare UPIN
OH0899211Medicare ID - Type Unspecified