Provider Demographics
NPI:1720608342
Name:LEACH, ZACHARY AARON (OD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:AARON
Last Name:LEACH
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 1:177 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-1080
Mailing Address - Country:US
Mailing Address - Phone:740-425-7000
Mailing Address - Fax:
Practice Address - Street 1:177 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-1080
Practice Address - Country:US
Practice Address - Phone:740-425-7000
Practice Address - Fax:740-425-7001
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHOPT.006885152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOPT.006885OtherOHIO VISION PROFESSIONALS BOARD