Provider Demographics
NPI:1083713622
Name:DRAPER, LESLIE A (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:DRAPER
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 1:511 SE 5TH AVE APT 819
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2969
Mailing Address - Country:US
Mailing Address - Phone:423-883-2535
Mailing Address - Fax:
Practice Address - Street 1:2583 E SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3203
Practice Address - Country:US
Practice Address - Phone:954-563-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD2640152W00000X
FLOPC4017152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3590042Medicaid
TN3590042Medicaid
TN103I411099Medicare PIN