Provider Demographics
NPI:1356680656
Name:LESLIE M MORO OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LESLIE M MORO OD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MORO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:831-443-4422
Mailing Address - Street 1:1630 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-5102
Mailing Address - Country:US
Mailing Address - Phone:831-443-4422
Mailing Address - Fax:831-443-4516
Practice Address - Street 1:1630 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-5102
Practice Address - Country:US
Practice Address - Phone:831-443-4422
Practice Address - Fax:831-443-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHS979AMedicare PIN