Provider Demographics
NPI:1073505814
Name:LEADINGHAM, WILLIAM E (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:LEADINGHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:NEURO VISUAL
Other - Middle Name:REHABILITATION
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 2005
Mailing Address - Street 2:STE 3
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2005
Mailing Address - Country:US
Mailing Address - Phone:606-329-8672
Mailing Address - Fax:606-329-1258
Practice Address - Street 1:1330 CARTER AVE
Practice Address - Street 2:STE 3
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7544
Practice Address - Country:US
Practice Address - Phone:606-329-1258
Practice Address - Fax:606-329-1258
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY748-DT152W00000X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
2202261OtherUNITED HEALTHCARE
WV0149565-001OtherMEDICAID
KY00748OtherVISION BENEFITS OF AMER.
181142OtherNATIONAL VISION ADMIN.
P00058622OtherRAILROAD MEDICARE
DA4299OtherRAILROAD MEDICARE (GROUP)
4904360001OtherOMERC
KY000000305764OtherANTHEM BLUECROSS
0005282086OtherAETNA
KY77903664Medicaid
DA4299OtherRAILROAD MEDICARE (GROUP)
KY0785901Medicare ID - Type Unspecified