Provider Demographics
NPI:1356407795
Name:CAPTAN, LEONARD (OPHTHALMIC DISPENSER)
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:
Last Name:CAPTAN
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2602
Mailing Address - Country:US
Mailing Address - Phone:914-698-2111
Mailing Address - Fax:914-381-1158
Practice Address - Street 1:245 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2602
Practice Address - Country:US
Practice Address - Phone:914-698-2111
Practice Address - Fax:914-381-1158
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004354156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1079620001Medicare NSC