Individual
TIMOTHY J LEAHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
201 N MADISON ST, PITTSFIELD, IL 62363-1447
(217) 285-4800
(217) 285-4850
Mailing address
201 N MADISON ST, PITTSFIELD, IL 62363-1447
(217) 285-4800
(217) 285-4850
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008656
IL
152W00000X
Optometrist
2000146553
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629027958
—
IL
05
—
1629027958
—
MO
Enumeration date
05/05/2006
Last updated
02/21/2018
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