Provider Demographics
NPI:1841269289
Name:OLLECH, LEO (OD)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:OLLECH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 E 10 ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230
Mailing Address - Country:US
Mailing Address - Phone:718-253-6071
Mailing Address - Fax:718-253-6071
Practice Address - Street 1:1552 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230
Practice Address - Country:US
Practice Address - Phone:718-258-0315
Practice Address - Fax:718-258-6622
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0043741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008238366Medicaid
NY07156Medicare PIN
NYC30902Medicare PIN
T48968Medicare UPIN