Provider Demographics
NPI:1245223163
Name:BENDER, LESLIE CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:CHARLES
Last Name:BENDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20932 BROOKHURST ST
Mailing Address - Street 2:STE 208
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-6638
Mailing Address - Country:US
Mailing Address - Phone:714-962-3371
Mailing Address - Fax:714-962-3745
Practice Address - Street 1:20932 BROOKHURST ST
Practice Address - Street 2:STE 208
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-6638
Practice Address - Country:US
Practice Address - Phone:714-962-3371
Practice Address - Fax:714-962-3745
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0059910Medicaid
CASD0059910Medicaid
CAOP5991Medicare ID - Type Unspecified
1023480001Medicare NSC