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General NPI Number Information
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NPI Number | 1831229913
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Entity Type | Individual
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Provider Name | LEON D INGHAM O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 3700 OWEN RD
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City | FENTON
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State | MI
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Zip | 48430-9193
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Country | US
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Telephone | 810-750-7345
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Fax | 810-750-7364
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Provider Business Mailing Address
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Address Line | 1941 STATE PARK RD
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City | ORTONVILLE
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State | MI
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Zip | 48462-9416
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Country | US
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Telephone | 810-715-1650
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Fax |
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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 | 4901004060
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License Number State | MI
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