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Individual

BEN LEONARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
43 INDUSTRIAL PKWY, CALVERT CITY, KY 42029-8416
(270) 395-8331
Mailing address
43 INDUSTRIAL PKWY, CALVERT CITY, KY 42029-8416
(270) 395-8331

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1896DT
KY
174400000X
Specialist
1896DT
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000781207
ANTHEM
KY
05
7100215320
KY
Enumeration date
07/17/2012
Last updated
10/15/2015
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