MEDICARE: NATHANIEL JAMES LEGGETT O.D.

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	5221	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144222613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL JAMES LEGGETT O.D.

Provider Business Mailing Address
First Line	:	4822 CLEVELAND AVE S
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44707-1034
Country	:	US
Telephone Number	:	330-484-2569
Fax Number	:	330-236-8188

Provider Business Practice Location Address
First Line	:	4822 CLEVELAND AVE S
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44707-1034
Country	:	US
Telephone Number	:	330-484-2569
Fax Number	:	330-236-8188

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

Provider Enumeration Date	:	08/13/2005
Last Update Date	:	05/11/2023

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