Provider Demographics
NPI:1790778231
Name:ELMS, LESLIE M (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:M
Last Name:ELMS
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 1:1105 E ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1908
Mailing Address - Country:US
Mailing Address - Phone:541-523-1649
Mailing Address - Fax:
Practice Address - Street 1:2150 3RD ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2609
Practice Address - Country:US
Practice Address - Phone:541-523-5858
Practice Address - Fax:541-523-7652
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2569AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR082263Medicaid
OR082263Medicaid
U67434Medicare UPIN
OR082263Medicaid