Provider Demographics
NPI:1659558955
Name:NATHANIEL J LEGGETT OD INC
Entity Type:Organization
Organization Name:NATHANIEL J LEGGETT OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LEGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-484-2569
Mailing Address - Street 1:3017A CLEVELAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-3625
Mailing Address - Country:US
Mailing Address - Phone:330-484-2569
Mailing Address - Fax:330-484-2263
Practice Address - Street 1:3017A CLEVELAND AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3625
Practice Address - Country:US
Practice Address - Phone:330-484-2569
Practice Address - Fax:330-484-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2714414Medicaid
OH2714414Medicaid
OHNA4181391Medicare PIN
OHLE4226581Medicare PIN
OH6058390001Medicare NSC
OHLE4181391Medicare PIN