Provider Demographics
NPI:1366723108
Name:LEADINGHAM EYE CARE CENTER - ASHLAND
Entity type:Organization
Organization Name:LEADINGHAM EYE CARE CENTER - ASHLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:LEADINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD PSC
Authorized Official - Phone:606-325-9659
Mailing Address - Street 1:PO BOX 1069
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105
Mailing Address - Country:US
Mailing Address - Phone:606-325-9659
Mailing Address - Fax:606-329-1258
Practice Address - Street 1:1330 CARTER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7544
Practice Address - Country:US
Practice Address - Phone:606-325-9659
Practice Address - Fax:606-329-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1659DT152W00000X
KY0748DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty