Provider Demographics
NPI:1700445731
Name:LEONARD, JOSHUA SHANE (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:SHANE
Last Name:LEONARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 E LEAH LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2437
Mailing Address - Country:US
Mailing Address - Phone:480-508-2155
Mailing Address - Fax:877-283-0573
Practice Address - Street 1:4022 E BROADWAY RD STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8824
Practice Address - Country:US
Practice Address - Phone:480-508-2155
Practice Address - Fax:877-283-0573
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002342152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist