Individual
JAMES A LEAVERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5325 GRAPE RD, MISHAWAKA, IN 46545-1344
(574) 277-6161
Mailing address
4123 S MICHIGAN ST, SOUTH BEND, IN 46614-2545
(574) 291-8900
(574) 299-8503
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001970
IN
Other
Enumeration date
06/29/2006
Last updated
07/08/2007
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