Provider Demographics
NPI:1295923977
Name:LEACH EYE CARE
Entity type:Organization
Organization Name:LEACH EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-693-2400
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-0239
Mailing Address - Country:US
Mailing Address - Phone:715-693-2400
Mailing Address - Fax:715-693-4699
Practice Address - Street 1:412 3RD ST
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-1425
Practice Address - Country:US
Practice Address - Phone:715-693-2400
Practice Address - Fax:715-693-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1677-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI47220Medicare PIN