Gary Leesue, O.D.
Individual provider Active NPI Optometrist · Colonie, NY
NPI 1396019121 · NPPES record last updated Feb 24, 2012
Key facts
- NPI
- 1396019121
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TUV007808-1 (NY)
- Practice address
- 1545 Central Ave
Colonie, NY 12205-5060 - Phone
- (518) 452-1111
- NPI assigned
- Feb 24, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY, GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140430000328 | NY | Practitioner - Optometry | 7113150004 | Reassigns benefits to 1 organization |
| I20180912003026 | GA | Practitioner - Optometry | 7113150004 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ga Doctors of Optometry LLC | Optometrist | Current |
Accepting new patients |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current | Accepting new patients |
| Ga Doctors of Optometry LLC | Optometrist | Current |
Accepting new patients |
| Mark Lynn OD & Associates, PC | Optometrist | Current |
Accepting new patients |
| Mark Lynn O.D. & Associates, PC | Current |
Accepting new patients | |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current |
Accepting new patients |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current |
Accepting new patients |
| America'S Best Contacts & Eyeglasses | Past | Accepting new patients |
Locations
4875 Altama Ave
Brunswick, GA 31520
Phone (912) 554-0010
50 Main Street Market Pl SE
Ste 100
Cartersville, GA 30121
Phone (770) 382-6379
2929 Turner Hill Rd
Ste 2625
Lithonia, GA 30038
Phone (770) 482-5050
318 Mall Blvd
Ste 600A
Savannah, GA 31406
Phone (912) 356-3833
1014 Northside Dr E
Statesboro, GA 30458
Phone (912) 764-9147
8614 Westwood Center Dr
Fl 9
Vienna, VA 22182
1950 Old Gallows Rd
Ste 520
Vienna, VA 22182
Interoperability endpoints
- 19345@visionworks.emadirect.md
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV007808-1 | NY | Yes |
Addresses
Primary practice location
1545 Central Ave
Colonie, NY 12205-5060
Mailing address
3070 NW 48TH Ter
Apt 301
Lauderdale Lakes, FL 33313-7243
Phone (305) 903-9239
Other providers in Colonie, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.