Provider Demographics
NPI:1003992603
Name:KOLKER, LESLIE R (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:R
Last Name:KOLKER
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 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE 286 WEST
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-328-1800
Mailing Address - Fax:516-358-2329
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE 286 WEST
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-328-1800
Practice Address - Fax:516-358-2329
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT 004430152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT49071Medicare UPIN
NY0370470001Medicare NSC
NYC32811Medicare PIN