Provider Demographics
NPI:1881627990
Name:LEDREW, JANICE (OD)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:LEDREW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 SYLVANIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3281
Mailing Address - Country:US
Mailing Address - Phone:937-320-2020
Mailing Address - Fax:937-320-0504
Practice Address - Street 1:89 SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3281
Practice Address - Country:US
Practice Address - Phone:937-320-2020
Practice Address - Fax:937-320-0504
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3209T536152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0469925Medicaid
OH1881627990OtherNPI
000000005917OtherANTHEM
2220162OtherUNITED HEALTHCARE
OH410035812OtherMEDICARE RAILROAD
OH0321780001Medicare NSC
0502676Medicare PIN
OH1881627990OtherNPI
0502675Medicare PIN