MEDICARE: DR. JEFFREY J LEIPHOLTZ 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	2003015589	MO

General Provider Information

NPI Number	:	1700845351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY J LEIPHOLTZ O.D.

Provider Business Mailing Address
First Line	:	PO BOX 7687
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65205-7687
Country	:	US
Telephone Number	:	573-882-1506
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 HOSPITAL DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-5276
Country	:	US
Telephone Number	:	573-882-1506
Fax Number	:

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	10/20/2011

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