Provider Demographics
NPI:1922073436
Name:BUSBY, LESLIE J (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:J
Last Name:BUSBY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2726
Mailing Address - Fax:916-853-7874
Practice Address - Street 1:7115 GREENBACK LN
Practice Address - Street 2:FL1
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-6133
Practice Address - Country:US
Practice Address - Phone:916-536-3550
Practice Address - Fax:916-536-3554
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CACA08683T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0086830Medicaid
CASD0086830Medicaid
CASD0086830Medicare ID - Type Unspecified
CASD0086830Medicaid