1255307930 NPI number — MS. WENDY J LESLIE O.D.

Table of content: MS. WENDY J LESLIE O.D. (NPI 1255307930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255307930 NPI number — MS. WENDY J LESLIE O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LESLIE
Provider First Name:
WENDY
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255307930
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 CORPORATION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYANNIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02601-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-778-9473
Provider Business Mailing Address Fax Number:
508-775-5913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 CORPORATION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYANNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02601-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-778-9473
Provider Business Practice Location Address Fax Number:
508-775-5913
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2495 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000031920 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0343404 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 779637 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 150674 . This is a "PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W16120 . This is a "BC/BS OF MA/HMO BLUE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com