Provider Demographics
NPI:1295708402
Name:RICH, LEONARD S (MD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:S
Last Name:RICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PROVIDENCE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4617
Mailing Address - Country:US
Mailing Address - Phone:251-650-1000
Mailing Address - Fax:251-650-1010
Practice Address - Street 1:601 PROVIDENCE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4617
Practice Address - Country:US
Practice Address - Phone:251-650-1000
Practice Address - Fax:251-650-1010
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL05984R207W00000X
AL9336207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000099616Medicaid
99616Medicare ID - Type Unspecified
C75247Medicare UPIN