Provider Demographics
NPI:1588913818
Name:LEANNA K LAPE-STOUDT OD PC
Entity type:Organization
Organization Name:LEANNA K LAPE-STOUDT OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEANNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAPE-STOUDT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-914-1018
Mailing Address - Street 1:25 TODD DR
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8618
Mailing Address - Country:US
Mailing Address - Phone:610-914-1018
Mailing Address - Fax:
Practice Address - Street 1:890 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2562
Practice Address - Country:US
Practice Address - Phone:717-721-6686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1743637Medicaid
PAU72210Medicare UPIN
PA006782Medicare PIN