Provider Demographics
NPI:1255307930
Name:LESLIE, WENDY J (OD)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:J
Last Name:LESLIE
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 1:113 CORPORATION ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2204
Mailing Address - Country:US
Mailing Address - Phone:508-778-9473
Mailing Address - Fax:508-775-5913
Practice Address - Street 1:113 CORPORATION ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2204
Practice Address - Country:US
Practice Address - Phone:508-778-9473
Practice Address - Fax:508-775-5913
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000031920OtherBMC HEALTHNET
MA0343404Medicaid
MA779637OtherTUFTS
MA150674OtherPILGRIM
MAW16120OtherBC/BS OF MA/HMO BLUE
MA779637OtherTUFTS
MAW16120OtherBC/BS OF MA/HMO BLUE