Provider Demographics
NPI:1972789154
Name:WILLIAM J. LEAHEY, OD
Entity type:Organization
Organization Name:WILLIAM J. LEAHEY, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEAHEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:518-237-0342
Mailing Address - Street 1:91 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2809
Mailing Address - Country:US
Mailing Address - Phone:518-237-0342
Mailing Address - Fax:518-235-9266
Practice Address - Street 1:91 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2809
Practice Address - Country:US
Practice Address - Phone:518-237-0342
Practice Address - Fax:518-235-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV3765-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0820850001Medicare NSC