Provider Demographics
NPI:1871532499
Name:LECKEY, DONALD M (OD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:M
Last Name:LECKEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15907-0580
Mailing Address - Country:US
Mailing Address - Phone:814-536-5343
Mailing Address - Fax:814-536-5343
Practice Address - Street 1:2750 WILLIAM PENN AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15909-1031
Practice Address - Country:US
Practice Address - Phone:814-322-1551
Practice Address - Fax:814-322-1552
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000622152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T27732Medicare UPIN