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General NPI Number Information
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NPI Number | 1073505814
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Entity Type | Individual
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Provider Name | WILLIAM E LEADINGHAM OD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 12/28/2012
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Provider Practice Location Address
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Address Line | 1330 CARTER AVE STE 3
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City | ASHLAND
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State | KY
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Zip | 41101-7544
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Country | US
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Telephone | 606-329-1258
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Fax | 606-329-1258
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Provider Business Mailing Address
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Address Line | PO BOX 2005 STE 3
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City | ASHLAND
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State | KY
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Zip | 41105-2005
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Country | US
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Telephone | 606-329-8672
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Fax | 606-329-1258
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 748-DT
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 748-DT
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 748-DT
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License Number State | KY
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