Provider Demographics
NPI:1497872196
Name:GRANT ALBERT, LESLIE ANNETTE (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANNETTE
Last Name:GRANT ALBERT
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:ANTTETTE
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2813 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1916
Mailing Address - Country:US
Mailing Address - Phone:301-933-1111
Mailing Address - Fax:301-922-1490
Practice Address - Street 1:2813 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1916
Practice Address - Country:US
Practice Address - Phone:301-933-1111
Practice Address - Fax:301-922-1490
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0791152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1578857694OtherGROUP NPI
MDGR180580Medicare PIN
MD1578857694OtherGROUP NPI