MEDICARE: DR NATHANIEL J. LEGGETT, INC

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

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	:	1447472329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR NATHANIEL J. LEGGETT, INC

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	:	PRESIDENT/TREASURER
Name	:	DR. NATHANIEL JAMES LEGGETT
Credential	:	OD
Telephone Number	:	330-484-2569

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	05/11/2023

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