Provider Demographics
NPI:1316940406
Name:TUCKER, LEONARD C (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:C
Last Name:TUCKER
Suffix:
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 1:6770 MAYFIELD RD
Mailing Address - Street 2:STE 338
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2299
Mailing Address - Country:US
Mailing Address - Phone:440-442-4330
Mailing Address - Fax:440-442-4695
Practice Address - Street 1:6770 MAYFIELD RD
Practice Address - Street 2:STE 338
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:440-442-4330
Practice Address - Fax:440-442-4695
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-01-6145-T207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH102139OtherKAISER
OH000000130732OtherANTHEM
OH0116789Medicaid
OH31134OtherCOLE MANAGED VISION
OH341345260030OtherCARESOURCE
OH1120700001OtherADMINISTAR FEDERAL
OH1120700001OtherADMINISTAR FEDERAL
OHTU0087062Medicare ID - Type UnspecifiedOHIO MEDICARE