Provider Demographics
NPI:1245374370
Name:LEFFLER, WILLIAM GLYNN JR (OD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GLYNN
Last Name:LEFFLER
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9810 ALTERNATE A1A
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-694-2239
Mailing Address - Fax:561-694-2174
Practice Address - Street 1:9810 ALTERNATE A1A
Practice Address - Street 2:SUITE 107
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-694-2239
Practice Address - Fax:561-694-2174
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1848152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT93913Medicare UPIN
FL19954Medicare ID - Type Unspecified