Provider Demographics
NPI:1255591079
Name:DR. LEO OLLECH
Entity type:Organization
Organization Name:DR. LEO OLLECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLLECH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-253-6071
Mailing Address - Street 1:1231 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4718
Mailing Address - Country:US
Mailing Address - Phone:718-253-6071
Mailing Address - Fax:718-253-6071
Practice Address - Street 1:1552 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4716
Practice Address - Country:US
Practice Address - Phone:718-258-0315
Practice Address - Fax:718-258-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0043741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008238366Medicaid
NYC30902Medicare PIN
NY008238366Medicaid
NYT48968Medicare UPIN