Provider Demographics
NPI:1346751724
Name:JILL MARIE LEIGHTER
Entity Type:Organization
Organization Name:JILL MARIE LEIGHTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEIGHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-431-7566
Mailing Address - Street 1:2700 S SANTA FE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-3204
Mailing Address - Country:US
Mailing Address - Phone:620-431-7566
Mailing Address - Fax:620-431-7588
Practice Address - Street 1:2700 S SANTA FE AVE STE A
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-3204
Practice Address - Country:US
Practice Address - Phone:620-431-7566
Practice Address - Fax:620-431-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSK1509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty