Provider Demographics
NPI:1316051808
Name:LEIKIN, ROBERT GENE (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GENE
Last Name:LEIKIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:19 BEECHAM CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6001
Mailing Address - Country:US
Mailing Address - Phone:410-654-8602
Mailing Address - Fax:410-654-8709
Practice Address - Street 1:2300 DULANEY VALLEY RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2739
Practice Address - Country:US
Practice Address - Phone:410-252-4500
Practice Address - Fax:410-560-9675
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0888152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401369700Medicaid
MD398M552FMedicare ID - Type UnspecifiedOPTOMETRY
MD401369700Medicaid