=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316078785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAROLD F. LEEPER, M.D., PH.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 58 16TH ST
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26003-3660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-234-2020
-----------------------------------------------------
Fax | 304-234-7158
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6252
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26003-0726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-234-2020
-----------------------------------------------------
Fax | 304-234-7158
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HAROLD FRANK LEEPER
-----------------------------------------------------
Credential | M.D., PH.D.
-----------------------------------------------------
Telephone | 304-234-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 16379
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------