Provider Demographics
NPI:1548234123
Name:LEFFINGWELL, H CHAPMAN (OD)
Entity Type:Individual
Prefix:
First Name:H
Middle Name:CHAPMAN
Last Name:LEFFINGWELL
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14151 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4528
Practice Address - Country:US
Practice Address - Phone:414-541-2100
Practice Address - Fax:414-541-2377
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2312152WX0102X
WI2312-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI87900-0002Medicare ID - Type Unspecified
WIT83425Medicare UPIN