Provider Demographics
NPI:1659780203
Name:PHAM, LESLIE (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:PHAM
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 1:8101 W JUDGE PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-1661
Mailing Address - Country:US
Mailing Address - Phone:504-206-3314
Mailing Address - Fax:504-278-2277
Practice Address - Street 1:925 E JUDGE PEREZ DR STE 1
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-5376
Practice Address - Country:US
Practice Address - Phone:504-345-2540
Practice Address - Fax:844-361-4912
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1791-725AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1659780203OtherNPI 2
LA2412191Medicaid