Individual
ILYA M LEYNGOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3015 E GOLDSTONE DR # 130, MERIDIAN, ID 83642-1549
(208) 900-4673
(208) 266-5033
Mailing address
3015 E GOLDSTONE DR STE 130, MERIDIAN, ID 83642-1224
(208) 900-4673
(208) 266-5033
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
ME112787
FL
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
2016-00134
NC
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
M-15568
ID
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
ME112787
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005984000
—
FL
01
—
14L01
BLUE CROSS BLUE SHIELD
FL
01
—
20024216
MEDICARE
ID
Enumeration date
02/08/2007
Last updated
04/08/2026
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