Healthcare Provider Details

I. General information

NPI: 1497721781
Provider Name (Legal Business Name): NICHOLAS JOHN LEONARDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 N REYNOLDS RD SUITE 230
TOLEDO OH
43615-2068
US

IV. Provider business mailing address

6591 W CENTRAL AVE SUITE 202
TOLEDO OH
43617-1087
US

V. Phone/Fax

Practice location:
  • Phone: 419-578-4367
  • Fax: 419-537-5639
Mailing address:
  • Phone: 419-517-6599
  • Fax: 419-517-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35062682
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number35062682
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: