Provider Demographics
NPI:1427740315
Name:MARGOLIS, LEAH (OD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MARGOLIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:HAZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:243 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3002
Mailing Address - Country:US
Mailing Address - Phone:216-618-0943
Mailing Address - Fax:
Practice Address - Street 1:1 MONTVALE AVE STE 501
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3567
Practice Address - Country:US
Practice Address - Phone:781-279-4418
Practice Address - Fax:617-573-5607
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOPT5652152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist