Provider Demographics
NPI:1982602132
Name:MCLEOD, JEFFREY M (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3730 WHIPPLE AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-4803
Mailing Address - Country:US
Mailing Address - Phone:330-493-3013
Mailing Address - Fax:330-493-3110
Practice Address - Street 1:3730 WHIPPLE AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-4803
Practice Address - Country:US
Practice Address - Phone:330-493-3013
Practice Address - Fax:330-493-3110
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4478/T1134152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU44088Medicare UPIN
OHMC0747713Medicare ID - Type Unspecified