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NPI Code Detail

MEDICARE: GRANT ALLAN LEPLEY O.D.

MEDICARE: GRANT ALLAN LEPLEY 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
1152W00000XOptometrist3307-035WI
2152W00000XOptometrist6216OH

General Provider Information

NPI Number : 1831538727
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRANT ALLAN LEPLEY O.D.
Provider Business Mailing Address
First Line : 355 N PETERS AVE
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-8258
Country : US
Telephone Number : 920-922-7121
Fax Number :
Provider Business Practice Location Address
First Line : 355 N PETERS AVE
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-8258
Country : US
Telephone Number : 920-922-7121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2013
Last Update Date : 03/12/2019

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Directions to “ GRANT ALLAN LEPLEY O.D.” Practice Location

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