Individual
LEAH WIEDEMAMN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
716 N HALIFAX AVE APT 9, DAYTONA BEACH, FL 32118-3852
(314) 583-0324
Mailing address
716 N HALIFAX AVE APT 13, DAYTONA BEACH, FL 32118-3856
(314) 583-0324
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2014021357
MO
Other
Enumeration date
12/02/2014
Last updated
06/08/2015
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