Provider Demographics
NPI:1871603647
Name:BABU, LEON T (OD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:T
Last Name:BABU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:L
Other - Middle Name:THOMAS
Other - Last Name:BABU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:307 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5201
Mailing Address - Country:US
Mailing Address - Phone:480-967-4801
Mailing Address - Fax:
Practice Address - Street 1:307 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5201
Practice Address - Country:US
Practice Address - Phone:480-967-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ17973001Medicaid
AZ17973001Medicaid
U44931Medicare UPIN