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NPI Code Detail

MEDICARE: MELINDA SUE LEGG O.D.

MEDICARE: MELINDA SUE LEGG 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
1152W00000XOptometrist2608AR

General Provider Information

NPI Number : 1306001847
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINDA SUE LEGG O.D.
Provider Business Mailing Address
First Line : PO BOX 196
Second Line :
City : JUNCTION CITY
State : AR
Zip : 71749-0196
Country : US
Telephone Number : 870-862-8069
Fax Number :
Provider Business Practice Location Address
First Line : 2730 N WEST AVE
Second Line :
City : EL DORADO
State : AR
Zip : 71730-3124
Country : US
Telephone Number : 870-862-8069
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2008
Last Update Date : 09/17/2012

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