Provider Demographics
NPI:1285621938
Name:LEISRING, JOSEPH P I (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:LEISRING
Suffix:I
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2234
Mailing Address - Country:US
Mailing Address - Phone:614-871-2080
Mailing Address - Fax:614-871-1301
Practice Address - Street 1:3814 BROADWAY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2234
Practice Address - Country:US
Practice Address - Phone:614-871-2080
Practice Address - Fax:614-871-1301
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3548/T538152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH410011217OtherRAILROAD MEDICARE
0560960002Medicare NSC
OH410011217OtherRAILROAD MEDICARE
OH0497795Medicare PIN