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General NPI Number Information
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NPI Number | 1104814599
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Entity Type | Individual
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Provider Name | JAMES C LEADINGHAM O.D., PSC
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Gender | Male
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 112 VINSON BLVD
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City | LOUISA
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State | KY
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Zip | 41230-1155
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Country | US
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Telephone | 606-638-4731
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Fax | 606-638-3523
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Provider Business Mailing Address
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Address Line | 112 VINSON BLVD
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City | LOUISA
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State | KY
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Zip | 41230
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Country | US
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Telephone | 606-638-4731
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Fax | 606-638-3523
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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 | 0731DT
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License Number State | KY
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