Provider Demographics
NPI:1154550929
Name:GAW, LEO A (OD)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:A
Last Name:GAW
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 1:108 N LORRAINE AVE # 2
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3222
Mailing Address - Country:US
Mailing Address - Phone:626-202-8431
Mailing Address - Fax:
Practice Address - Street 1:125 LAWRENCE RD E
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-3844
Practice Address - Country:US
Practice Address - Phone:315-455-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist