Provider Demographics
NPI:1740590975
Name:JOSEPH LEGIEC, O.D., P.A.
Entity type:Organization
Organization Name:JOSEPH LEGIEC, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGIEC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-225-0557
Mailing Address - Street 1:11160 LAKELAND CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913
Mailing Address - Country:US
Mailing Address - Phone:239-225-0557
Mailing Address - Fax:
Practice Address - Street 1:2523 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1413
Practice Address - Country:US
Practice Address - Phone:239-368-0979
Practice Address - Fax:239-368-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL002844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty