Healthcare Provider Details

I. General information

NPI: 1366723108
Provider Name (Legal Business Name): LEADINGHAM EYE CARE CENTER - ASHLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 CARTER AVE SUITE 1
ASHLAND KY
41101-7544
US

IV. Provider business mailing address

PO BOX 1069
ASHLAND KY
41105
US

V. Phone/Fax

Practice location:
  • Phone: 606-325-9659
  • Fax: 606-329-1258
Mailing address:
  • Phone: 606-325-9659
  • Fax: 606-329-1258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1659DT
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0748DT
License Number StateKY

VIII. Authorized Official

Name: DR. WILLIAM ERNEST LEADINGHAM
Title or Position: MANAGING PARTNER
Credential: OD PSC
Phone: 606-325-9659