Provider Demographics
NPI:1902945637
Name:MUSCOLINO, LEONARD ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:ANTHONY
Last Name:MUSCOLINO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5599
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-5599
Mailing Address - Country:US
Mailing Address - Phone:602-295-4103
Mailing Address - Fax:
Practice Address - Street 1:1607 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2507
Practice Address - Country:US
Practice Address - Phone:602-295-4103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ559152W00000X
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ26117OtherAVESIS
AZ18242OtherUNITED HEALTH-SPECTERA
AZ18242OtherUNITED HEALTH-SPECTERA