Provider Demographics
NPI:1801588793
Name:LEAVENGOOD, DAVID JAMES (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:LEAVENGOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 PALM AIRE DR
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-2235
Mailing Address - Country:US
Mailing Address - Phone:353-292-2262
Mailing Address - Fax:
Practice Address - Street 1:1716 PALM AIRE DR
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-2235
Practice Address - Country:US
Practice Address - Phone:353-292-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7274156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician