Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 958 | TN |
NPI | 1215052493 |
---|---|
Provider Name | Mr. Jeffery Lee Leonard |
First Address | Oldfort, TN 37362 |
Second Address | Cleveland, TN 37311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |