Provider Demographics
NPI:1346381829
Name:TOLL, LESLIE (OD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:TOLL
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 1:10050 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:SUITE F100
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3501
Mailing Address - Country:US
Mailing Address - Phone:410-461-2020
Mailing Address - Fax:410-461-2672
Practice Address - Street 1:10050 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE F100
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3501
Practice Address - Country:US
Practice Address - Phone:410-461-2020
Practice Address - Fax:410-461-2672
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist