Provider Demographics
NPI:1790047462
Name:LESLIE V. BUSBY, O.D., P.C.
Entity Type:Organization
Organization Name:LESLIE V. BUSBY, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:BUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:575-437-9326
Mailing Address - Street 1:1209 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6727
Mailing Address - Country:US
Mailing Address - Phone:575-437-9326
Mailing Address - Fax:575-434-6995
Practice Address - Street 1:1209 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6727
Practice Address - Country:US
Practice Address - Phone:575-437-9326
Practice Address - Fax:575-434-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOP2207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2590491Medicare PIN
NMT74934Medicare UPIN