Provider Demographics
NPI:1528168168
Name:RAY, LEAH L (OD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:L
Last Name:RAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:L
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7706 NE 56TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6244
Mailing Address - Country:US
Mailing Address - Phone:503-550-3737
Mailing Address - Fax:
Practice Address - Street 1:8400 NE VANCOUVER MALL LOOP
Practice Address - Street 2:SUITE 110
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6671
Practice Address - Country:US
Practice Address - Phone:360-254-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2014-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist