Provider Demographics
NPI:1548346117
Name:MCCONNAUGHEY, LEAH L (OD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:L
Last Name:MCCONNAUGHEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133
Mailing Address - Country:US
Mailing Address - Phone:937-393-3212
Mailing Address - Fax:937-393-5065
Practice Address - Street 1:934 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133
Practice Address - Country:US
Practice Address - Phone:937-393-3212
Practice Address - Fax:937-393-5065
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7376419OtherAETNA
OH000000253056OtherANTHEM
OH2447418Medicaid
OH2447418Medicaid
OH000000253056OtherANTHEM