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Organization

MARTY R LEGGETT OD PA

Active
Parent organization
MARTY R. LEGGETT, O.D.
Organization subpart
Yes

Provider details

NPI number
Legal business name
MARTY R. LEGGETT, O.D.
Authorized official
DR. MARTY R LEGGETT OD (OWNER)
(352) 391-2967
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
OC0002242
FL
152W00000X
Optometrist
Primary
OPC2242
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
078819800
FL
Enumeration date
12/11/2007
Last updated
01/02/2013
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