Individual
DR. LEROY TAYLOR KINCANNON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1542 GOLF COURSE RD, SUITE 201, GRAND RAPIDS, MN 55744-9603
(218) 326-3433
(218) 326-3435
Mailing address
3221 E 4TH ST, DULUTH, MN 55804-1831
(218) 260-8536
(218) 262-3855
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2466
MN
Other
Enumeration date
08/19/2006
Last updated
07/08/2007
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