Provider Demographics
NPI:1982728838
Name:LEDDON, JOHN E JR (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:LEDDON
Suffix:JR
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E BANK ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-1209
Mailing Address - Country:US
Mailing Address - Phone:585-589-5531
Mailing Address - Fax:585-589-5532
Practice Address - Street 1:15 E BANK ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1209
Practice Address - Country:US
Practice Address - Phone:585-589-5531
Practice Address - Fax:585-589-5532
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003650-1156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00992058Medicaid