Individual
DR. LEONARD R. PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1217 OAK KNOLL DR, FORT WORTH, TX 76117-5505
(817) 831-6141
(682) 647-3909
Mailing address
1217 OAK KNOLL DR, FORT WORTH, TX 76117-5505
(817) 831-6141
(682) 647-3909
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3719T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88047
OPTICARE PROVIDER I.D.
TX
Enumeration date
08/31/2006
Last updated
07/08/2007
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