Provider Demographics
NPI:1518059047
Name:GREGOR, LESLIE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:GREGOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:GREGOR
Other - Last Name:HEMBREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:14304 BEVERLY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2346
Mailing Address - Country:US
Mailing Address - Phone:913-681-9365
Mailing Address - Fax:
Practice Address - Street 1:15100 METCALF AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2808
Practice Address - Country:US
Practice Address - Phone:913-685-0212
Practice Address - Fax:913-685-0092
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1352-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU11866Medicare UPIN
KSM962436Medicare ID - Type Unspecified