Individual
CHARLES LEAHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.,M.S.
Contact information
Practice address
243 CHARLES ST, BOSTON, MA 02114-3002
(617) 573-4296
Mailing address
243 CHARLES ST, BOSTON, MA 02114-3002
(617) 573-4296
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
3354
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3354
MA LICENSE
MA
01
—
ML0406327M
TPA LICENSE
MA
Enumeration date
11/29/2006
Last updated
08/02/2013
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