Provider Demographics
NPI:1033274279
Name:WOODCOCK, LESLIE D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:D
Last Name:WOODCOCK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5100 W TAFT RD STE 3L
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3809
Mailing Address - Country:US
Mailing Address - Phone:315-452-2211
Mailing Address - Fax:315-452-2231
Practice Address - Street 1:5100 W TAFT RD STE 3L
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3809
Practice Address - Country:US
Practice Address - Phone:315-452-2211
Practice Address - Fax:315-452-2231
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232345-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02571882Medicaid
NYRA2698Medicare ID - Type Unspecified
NY02571882Medicaid