Provider Demographics
NPI:1396798484
Name:LERNER, LEONID EDUARD (MD, PHD)
Entity type:Individual
Prefix:
First Name:LEONID
Middle Name:EDUARD
Last Name:LERNER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 AVOCADO AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7703
Mailing Address - Country:US
Mailing Address - Phone:949-721-1701
Mailing Address - Fax:949-612-1910
Practice Address - Street 1:3 CORPORATE PLAZA DR
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7905
Practice Address - Country:US
Practice Address - Phone:949-721-1701
Practice Address - Fax:949-612-1910
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54458207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB770XOtherMEDICARE PTAN
CACB770YOtherMEDICARE PTAN
CACB770XOtherMEDICARE PTAN