# MARTY R LEGGETT OD PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARTY R. LEGGETT, O.D.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275716433
- **Legal business name:** MARTY R. LEGGETT, O.D.
- **Authorized official:** DR. MARTY R LEGGETT OD (OWNER)
- **Authorized official phone:** (352) 391-2967

## Contact information

- **Practice address:** 309 W MAIN ST., LEESBURG, FL 34748
- **Practice address phone:** (352) 391-2967
- **Practice address fax:** (352) 391-2967
- **Mailing address:** P.O. BOX 490012, LEESBURG, FL 34749-0012
- **Mailing address phone:** (352) 391-2967
- **Mailing address fax:** (352) 391-2967

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OC0002242 | FL | — |
| 152W00000X | Optometrist | OPC2242 | FL | Yes |

## Other

- **Enumeration date:** 12/11/2007
- **Last updated:** 01/02/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 078819800 | — | FL |