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General NPI Number Information
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NPI Number | 1740590975
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Entity Type | Organization
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Legal Business Name | JOSEPH LEGIEC, O.D., P.A.
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 2523 LEE BLVD
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City | LEHIGH ACRES
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State | FL
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Zip | 33971-1413
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Country | US
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Telephone | 239-368-0979
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Fax | 239-368-2591
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Provider Business Mailing Address
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Address Line | 11160 LAKELAND CIRCLE
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City | FORT MYERS
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State | FL
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Zip | 33913
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Country | US
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Telephone | 239-225-0557
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH LEGIEC
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Credential | O.D.
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Telephone | 239-225-0557
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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 | 002844
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License Number State | FL
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