1114061207 NPI number — DR. LEONARD H. FORBES, O.D.

Table of content: (NPI 1114061207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114061207 NPI number — DR. LEONARD H. FORBES, O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. LEONARD H. FORBES, O.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114061207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12737 GLENOAKS BLVD STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLMAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91342-4724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-376-1015
Provider Business Mailing Address Fax Number:
818-367-3593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12737 GLENOAKS BLVD STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-4724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-367-1015
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FORBES
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
818-367-1015

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4873T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GSD005540 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: OP4873 . This is a "MEDICARE ID - TYPE UNSPECIFIED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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