Provider Demographics
NPI:1619922333
Name:CHIN, LESLIE R (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:R
Last Name:CHIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-2440
Mailing Address - Country:US
Mailing Address - Phone:870-572-3408
Mailing Address - Fax:870-572-4130
Practice Address - Street 1:126 GARLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-2440
Practice Address - Country:US
Practice Address - Phone:870-572-3408
Practice Address - Fax:870-572-4130
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2040152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103714722Medicaid
T20227Medicare UPIN
AR48771Medicare PIN
AR0392300001Medicare NSC