Provider Demographics
NPI:1215052493
Name:LEONARD, JEFFERY LEE (LDO)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:LEE
Last Name:LEONARD
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 BUCKS POCKET RD.
Mailing Address - Street 2:
Mailing Address - City:OLDFORT
Mailing Address - State:TN
Mailing Address - Zip Code:37362
Mailing Address - Country:US
Mailing Address - Phone:423-479-3195
Mailing Address - Fax:
Practice Address - Street 1:2733 KEITH ST.
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:423-472-0426
Practice Address - Fax:423-559-0129
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN958156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician