Provider Demographics
NPI:1821285016
Name:DUDLEY, LEANNA MARIE (OD)
Entity type:Individual
Prefix:
First Name:LEANNA
Middle Name:MARIE
Last Name:DUDLEY
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 1:1450 HOYT ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4763
Mailing Address - Country:US
Mailing Address - Phone:303-433-3277
Mailing Address - Fax:303-433-3278
Practice Address - Street 1:1450 HOYT ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4763
Practice Address - Country:US
Practice Address - Phone:303-433-3277
Practice Address - Fax:303-433-3278
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY56007344152WV0400X
CO2707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy