Provider Demographics
NPI:1497721781
Name:LEONARDY, NICHOLAS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOHN
Last Name:LEONARDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6591 W CENTRAL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1087
Mailing Address - Country:US
Mailing Address - Phone:419-517-6599
Mailing Address - Fax:419-517-0503
Practice Address - Street 1:2865 N REYNOLDS RD
Practice Address - Street 2:SUITE 230
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2068
Practice Address - Country:US
Practice Address - Phone:419-578-4367
Practice Address - Fax:419-537-5639
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35062682207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000026371OtherANTHEM
OH0852439Medicaid
LE0704641OtherPTAN
341196311OtherTAX IDENTIFICATION NUMBER
OH0704641Medicare PIN
LE0704641OtherPTAN