Provider Demographics
NPI:1487747085
Name:LEAHEY EYE CLINIC
Entity type:Organization
Organization Name:LEAHEY EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DORAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-458-4546
Mailing Address - Street 1:9 CENTRAL STREET
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1927
Mailing Address - Country:US
Mailing Address - Phone:978-458-4546
Mailing Address - Fax:978-932-9264
Practice Address - Street 1:9 CENTRAL STREET
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1927
Practice Address - Country:US
Practice Address - Phone:978-458-4546
Practice Address - Fax:978-932-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9700765Medicaid
MAM10290Medicare ID - Type UnspecifiedMEDICARE