Provider Demographics
NPI:1801985148
Name:LEACH, LARA (OD)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 NORTHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4400
Mailing Address - Country:US
Mailing Address - Phone:614-739-0660
Mailing Address - Fax:614-739-0661
Practice Address - Street 1:180 NORTHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4400
Practice Address - Country:US
Practice Address - Phone:614-739-0660
Practice Address - Fax:614-739-0661
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.005399152W00000X
OH5399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8854824Medicare UPIN
WA2031482Medicaid