MEDICARE: DR. JOSEPH P. LEISRING I O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3548/T538	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410011217	OTHER	OH	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1285621938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH P. LEISRING I O.D.

Provider Business Mailing Address
First Line	:	3814 BROADWAY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2234
Country	:	US
Telephone Number	:	614-871-2080
Fax Number	:	614-871-1301

Provider Business Practice Location Address
First Line	:	3814 BROADWAY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2234
Country	:	US
Telephone Number	:	614-871-2080
Fax Number	:	614-871-1301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2005
Last Update Date	:	05/02/2012

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