Provider Demographics
NPI:1386812295
Name:BARRY, LELAND STANN (OD)
Entity type:Individual
Prefix:DR
First Name:LELAND
Middle Name:STANN
Last Name:BARRY
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 1:651 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2512
Mailing Address - Country:US
Mailing Address - Phone:516-670-0600
Mailing Address - Fax:
Practice Address - Street 1:651 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2512
Practice Address - Country:US
Practice Address - Phone:516-670-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0040951152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01059952Medicaid
NYA100052268Medicare PIN
NYA4000682720Medicare PIN