Provider Demographics
NPI:1316386840
Name:GROTTON, LEAH D (OD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:D
Last Name:GROTTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14 DRESSER RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9767
Mailing Address - Country:US
Mailing Address - Phone:207-318-8741
Mailing Address - Fax:
Practice Address - Street 1:58 STATE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5124
Practice Address - Country:US
Practice Address - Phone:207-623-5099
Practice Address - Fax:207-623-7124
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT938152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist