Provider Demographics
NPI:1073242418
Name:HILTON, LESLIE (LDO)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HILTON
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 MONTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:SC
Mailing Address - Zip Code:29742-5758
Mailing Address - Country:US
Mailing Address - Phone:803-610-3610
Mailing Address - Fax:
Practice Address - Street 1:1151 STONECREST BLVD
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-6555
Practice Address - Country:US
Practice Address - Phone:803-578-4135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1298156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician