Provider Demographics
NPI:1316221831
Name:MELINDA S. LEGG OD
Entity Type:Organization
Organization Name:MELINDA S. LEGG OD
Other - Org Name:FAMILY VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LEGG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-312-0332
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71749-0196
Mailing Address - Country:US
Mailing Address - Phone:870-862-8069
Mailing Address - Fax:
Practice Address - Street 1:2730 N WEST AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-3124
Practice Address - Country:US
Practice Address - Phone:870-862-8069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2608152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty