Provider Demographics
NPI:1790941185
Name:SCIUMBATO, LESLIE A (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:SCIUMBATO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3635 S SONCY RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6402
Mailing Address - Country:US
Mailing Address - Phone:806-356-6868
Mailing Address - Fax:806-351-0120
Practice Address - Street 1:3635 S SONCY RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6402
Practice Address - Country:US
Practice Address - Phone:806-356-6868
Practice Address - Fax:806-351-0120
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7294T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790941185OtherNPI