Provider Demographics
NPI:1730172842
Name:LEAHEY, WILLIAM JAMES JR (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:LEAHEY
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:12 GREEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-5801
Mailing Address - Country:US
Mailing Address - Phone:518-283-5054
Mailing Address - Fax:518-283-5054
Practice Address - Street 1:91 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2809
Practice Address - Country:US
Practice Address - Phone:518-237-0342
Practice Address - Fax:518-235-9266
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003765-0152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY442580078OtherRAILROAD MEDICARE
NYT26498Medicare UPIN
NY0820850001Medicare NSC
NY442580078OtherRAILROAD MEDICARE