Provider Demographics
NPI:1104014687
Name:JAMES C LEADINGHAM, O.D., PSC
Entity type:Organization
Organization Name:JAMES C LEADINGHAM, O.D., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEADINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD PSC
Authorized Official - Phone:606-638-4731
Mailing Address - Street 1:112 VINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230
Mailing Address - Country:US
Mailing Address - Phone:606-638-4731
Mailing Address - Fax:606-638-3523
Practice Address - Street 1:112 VINSON BLVD
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-1155
Practice Address - Country:US
Practice Address - Phone:606-638-4731
Practice Address - Fax:606-638-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0731DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000305678OtherBCBS
WV0149556000Medicaid
1432032OtherUNITED MIN WORKERS H&R
DB8758OtherRR MEDICARE
1432032OtherUNITED MIN WORKERS H&R
000000305678OtherBCBS