Provider Demographics
NPI:1376928879
Name:SMALL, LESLIE REBECCA (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:REBECCA
Last Name:SMALL
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 1:900 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1119
Mailing Address - Country:US
Mailing Address - Phone:305-326-6111
Mailing Address - Fax:305-326-6311
Practice Address - Street 1:900 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1119
Practice Address - Country:US
Practice Address - Phone:305-326-6111
Practice Address - Fax:305-326-6311
Is Sole Proprietor?:No
Enumeration Date:2015-07-25
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 5103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist