Provider Demographics
NPI:1447472329
Name:DR NATHANIEL J. LEGGETT, INC
Entity type:Organization
Organization Name:DR NATHANIEL J. LEGGETT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LEGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-484-2569
Mailing Address - Street 1:4822 CLEVELAND AVE S
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-1034
Mailing Address - Country:US
Mailing Address - Phone:330-484-2569
Mailing Address - Fax:330-236-8188
Practice Address - Street 1:4822 CLEVELAND AVE S
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-1034
Practice Address - Country:US
Practice Address - Phone:330-484-2569
Practice Address - Fax:330-236-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2796112Medicaid
OHDR9374911Medicare PIN