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Organization

LEDER RETINA

Active
Other names
Leder Retina & Uveitis Specialist
Organization subpart
No

Provider details

NPI number
Authorized official
HENRY ALEXANDER LEDER MD (OWNER)
(904) 201-9887
Entity
Organization

Contact information

Practice address
13241 BARTRAM PARK BLVD UNIT 809, JACKSONVILLE, FL 32258-5216
(904) 201-9887
(904) 325-6434
Mailing address
332 N LOMBARDY LOOP, FRUIT COVE, FL 32259-5266
(203) 520-7393

Taxonomy

Speciality
Code
Description
License number
State
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
207WX0108X
Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
261Q00000X
Clinic/Center
D64669
MD
261QS0132X
Ophthalmologic Surgery Clinic/Center
D64669
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
048036300
FL
Enumeration date
07/10/2017
Last updated
04/02/2020
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