Provider Demographics
NPI:1215930557
Name:LEACH, MORGAN R (OD)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:R
Last Name:LEACH
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 1:1900 4TH ST NE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1996
Mailing Address - Country:US
Mailing Address - Phone:406-453-1900
Mailing Address - Fax:406-453-1700
Practice Address - Street 1:1900 4TH ST NE
Practice Address - Street 2:SUITE 5
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1996
Practice Address - Country:US
Practice Address - Phone:406-453-1900
Practice Address - Fax:406-453-1700
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT534 OPT152W00000X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0679000001OtherDMERC
MT410041206OtherRAIL ROAD MEDICARE
MT027590OtherBCBS OF MT
MT0481202Medicaid
MT0481202Medicaid