Provider Demographics
NPI:1790345429
Name:KINDER, LESLIE (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:KINDER
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 1:2311 MCKELVEY RD
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-1531
Mailing Address - Country:US
Mailing Address - Phone:314-434-9450
Mailing Address - Fax:314-434-0151
Practice Address - Street 1:2311 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-1531
Practice Address - Country:US
Practice Address - Phone:314-434-9450
Practice Address - Fax:314-434-0151
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2131152W00000X
MO2019021310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist