Provider Demographics
NPI:1508260852
Name:JOSEPH M LEPPEK O.D. PLLC
Entity type:Organization
Organization Name:JOSEPH M LEPPEK O.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEPPEK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-341-3900
Mailing Address - Street 1:9149 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438-9265
Mailing Address - Country:US
Mailing Address - Phone:810-341-3900
Mailing Address - Fax:
Practice Address - Street 1:1425 N LEROY ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2763
Practice Address - Country:US
Practice Address - Phone:810-629-2041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty