Provider Demographics
NPI:1972594927
Name:LEGRANDE, JEFFREY NELSON (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NELSON
Last Name:LEGRANDE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8202 N LOOP 1604 W
Mailing Address - Street 2:STE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2897
Mailing Address - Country:US
Mailing Address - Phone:210-691-4733
Mailing Address - Fax:210-691-3322
Practice Address - Street 1:8202 N LOOP 1604 W STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2898
Practice Address - Country:US
Practice Address - Phone:210-691-4733
Practice Address - Fax:210-424-9156
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6528T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist