Provider Demographics
NPI:1831538727
Name:LEPLEY, GRANT ALLAN (OD)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:ALLAN
Last Name:LEPLEY
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 1:355 N PETERS AVE
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-8258
Mailing Address - Country:US
Mailing Address - Phone:920-922-7121
Mailing Address - Fax:
Practice Address - Street 1:355 N PETERS AVE
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-8258
Practice Address - Country:US
Practice Address - Phone:920-922-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3307-035152W00000X
OH6216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist