Leonard R. Pack, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3719T Issued in TX

Practice address

1217 Oak Knoll Dr
Fort Worth, TX 76117-5505

Phone

(817) 831-6141

Fax

(682) 647-3909

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Visionary Eyecare Center LLC

  • Optometrist
  • Fort Worth, TX
  • NPI 1326552985
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568573574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1217 OAK KNOLL DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761175505",
            "telephone_number": "817-831-6141",
            "fax_number": "682-647-3909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 OAK KNOLL DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761175505",
            "telephone_number": "817-831-6141",
            "fax_number": "682-647-3909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "LEONARD",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "3719T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTICARE PROVIDER I.D.",
            "identifier": "88047",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Latiah Pace, RCP
• Holly Lynn Pacenta, M.D.
• Pack Optical
• Andrew Pack, MD
• Christopher Shawn Pack, D.D.S.
• Whitney Childs Pack, CPNP-AC
• Eric Alan Packwood, MD
• Sydney Padget, OTR
• Alyssa Padilla
• Audrey Padilla

• Optometrist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.