Provider Demographics
NPI:1124425111
Name:LEIGH MAST, OD, PLLC
Entity type:Organization
Organization Name:LEIGH MAST, OD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-266-4005
Mailing Address - Street 1:2317 SW 320TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2567
Mailing Address - Country:US
Mailing Address - Phone:253-952-5547
Mailing Address - Fax:
Practice Address - Street 1:2317 SW 320TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2567
Practice Address - Country:US
Practice Address - Phone:253-952-5547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60301603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty