Organization
DONALD B. LEACH, O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD B LEACH O.D. (PRESIDENT/DOCTOR)
(505) 865-4812
Entity
Organization
Contact information
Practice address
943 MAIN STREET SW, LOS LUNAS, NM 87031-8748
(505) 865-4812
(505) 865-3767
Mailing address
943 MAIN STREET SW, LOS LUNAS, NM 87031-8748
(505) 865-4812
(505) 865-3767
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
245/OP2245
NM
302F00000X
Exclusive Provider Organization
245/OP2245
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10007839
LOVELACE HEALTH, SR
NM
01
—
201005637
PRESBYTERIAN HEALTH, SR
NM
01
—
826580615
RAILROAD MEDICARE
NM
01
—
999995614
VSP
NM
01
—
NM00P054
BLUECROSS BLUESHIELD
NM
05
—
NMB2264
—
NM
Enumeration date
03/14/2008
Last updated
10/09/2012
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