| |
9565 S 700 E Ste 101, Sandy, UT 84070-3482 | |
(801) 572-3937 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 9565 S 700 E Ste 101, Sandy, Utah |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1962840108 | NPI | - | NPPES |
1962840108 | Medicaid | UT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Provider Name | Benjamin H Leishman |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1942438015 PECOS PAC ID: 0244382711 Enrollment ID: I20120105000657 |
Mailing Address | Practice Location Address |
---|---|
9565 S 700 E Ste 101, Sandy, UT 84070-3482 Ph: (385) 202-3937 | 9565 S 700 E Ste 101, Sandy, UT 84070-3482 Ph: (801) 572-3937 |