Provider Demographics
NPI:1477617058
Name:DOOLEY, LESLIE LOVE (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:LOVE
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:LOVE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 3827
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-3827
Mailing Address - Country:US
Mailing Address - Phone:361-888-4288
Mailing Address - Fax:361-888-4293
Practice Address - Street 1:900 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2028
Practice Address - Country:US
Practice Address - Phone:361-888-4288
Practice Address - Fax:361-888-4293
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS 828 TA 356152W00000X
TX9744T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2210079OtherUNITED HEALTH CARE
AL36568-001OtherDAVIS
AL20120OtherTHE OATH
AL410036815OtherRR MCARE
AL11357OtherSPECTERA
ALAL0828OtherEYEMED
AL000079262Medicaid
AL132497OtherCOLE
TX421792901Medicaid
AL510-79262OtherBCBS
AL410036815OtherRR MCARE