Provider Demographics
NPI:1194891838
Name:RICE, LEONIDAS EDWIN JR (MD)
Entity type:Individual
Prefix:
First Name:LEONIDAS
Middle Name:EDWIN
Last Name:RICE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 W DUE W AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115
Mailing Address - Country:US
Mailing Address - Phone:615-860-7481
Mailing Address - Fax:615-860-7482
Practice Address - Street 1:607 W DUE W AVE
Practice Address - Street 2:STE 115
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-860-7481
Practice Address - Fax:615-860-7482
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000013734207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3848450Medicaid
3371932Medicare ID - Type Unspecified
TN3848452Medicare ID - Type Unspecified
TN3848450Medicaid