Provider Demographics
NPI:1144222613
Name:LEGGETT, NATHANIEL JAMES (OD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:JAMES
Last Name:LEGGETT
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 1:4822 CLEVELAND AVE S
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-1034
Mailing Address - Country:US
Mailing Address - Phone:330-484-2569
Mailing Address - Fax:330-236-8188
Practice Address - Street 1:4822 CLEVELAND AVE S
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-1034
Practice Address - Country:US
Practice Address - Phone:330-484-2569
Practice Address - Fax:330-236-8188
Is Sole Proprietor?:No
Enumeration Date:2005-08-13
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2714414Medicaid
OHLE4226581Medicare PIN
OHU86484Medicare UPIN
OH2714414Medicaid