MEDICARE: DR. THEODORE REX LEGLER II OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18001572B	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1679673495	OTHER	IN	GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023017639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE REX LEGLER II OD

Provider Business Mailing Address
First Line	:	219 E WASHINGTON ST
Second Line	:
City	:	MARTINSVILLE
State	:	IN
Zip	:	46151-1554
Country	:	US
Telephone Number	:	765-342-6654
Fax Number	:	765-342-0418

Provider Business Practice Location Address
First Line	:	219 E WASHINGTON ST
Second Line	:
City	:	MARTINSVILLE
State	:	IN
Zip	:	46151-1554
Country	:	US
Telephone Number	:	765-342-6654
Fax Number	:	765-342-0418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	10/01/2008

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