Provider Demographics
NPI:1134131964
Name:HARPER, LEIGHTON ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:LEIGHTON
Middle Name:ALLEN
Last Name:HARPER
Suffix:
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 1:1864 BIRCH RUN RD
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-3572
Mailing Address - Country:US
Mailing Address - Phone:812-238-1214
Mailing Address - Fax:
Practice Address - Street 1:114 W HONEY CREEK PKWY
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4114
Practice Address - Country:US
Practice Address - Phone:812-234-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU88307Medicare UPIN
IN218360Medicare ID - Type Unspecified