Provider Demographics
NPI:1982607412
Name:LEIGHTON, STEVEN JAMES
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAMES
Last Name:LEIGHTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7148 LAWYERS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3906
Mailing Address - Country:US
Mailing Address - Phone:704-535-9252
Mailing Address - Fax:704-535-6634
Practice Address - Street 1:7148 LAWYERS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-3906
Practice Address - Country:US
Practice Address - Phone:704-535-9252
Practice Address - Fax:704-535-6634
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890980BMedicaid
NC2467988Medicare ID - Type Unspecified
NC890980BMedicaid
NC0976200001Medicare NSC