Provider Demographics
NPI:1023017639
Name:LEGLER, THEODORE REX II (OD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:REX
Last Name:LEGLER
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1554
Mailing Address - Country:US
Mailing Address - Phone:765-342-6654
Mailing Address - Fax:765-342-0418
Practice Address - Street 1:219 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1554
Practice Address - Country:US
Practice Address - Phone:765-342-6654
Practice Address - Fax:765-342-0418
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001572B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1679673495OtherGROUP NPI
IN200076560AMedicaid
IN1679673495OtherGROUP NPI
IN200076560AMedicaid
IN192350Medicare PIN