Provider Demographics
NPI:1134182025
Name:LEON, STEVE ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:ALAN
Last Name:LEON
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 1:10 W ADAMS AVE
Mailing Address - Street 2:PO BOX 200
Mailing Address - City:VILLA GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61956-1513
Mailing Address - Country:US
Mailing Address - Phone:217-832-2111
Mailing Address - Fax:217-832-9935
Practice Address - Street 1:10 W ADAMS AVE
Practice Address - Street 2:
Practice Address - City:VILLA GROVE
Practice Address - State:IL
Practice Address - Zip Code:61956-1513
Practice Address - Country:US
Practice Address - Phone:217-832-2111
Practice Address - Fax:217-832-9935
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL467325152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT38099Medicare UPIN
IL932060002Medicare PIN