Provider Demographics
NPI:1386614782
Name:LEACH, OD, SUZANNE LEAH (OD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:LEAH
Last Name:LEACH, OD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:LEAH
Other - Last Name:LEACH, OD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1845 STATE ROUTE 127 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-9284
Mailing Address - Country:US
Mailing Address - Phone:937-472-5665
Mailing Address - Fax:937-472-3933
Practice Address - Street 1:1845 STATE ROUTE 127 N
Practice Address - Street 2:SUITE A
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9284
Practice Address - Country:US
Practice Address - Phone:937-472-5665
Practice Address - Fax:937-472-3933
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4119/T938152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0230824Medicaid
OH0230824Medicaid