Provider Demographics
NPI:1952458804
Name:GUY, LESLIE W (OD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:W
Last Name:GUY
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 1:217 WILD TURKEY RDG
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-4279
Mailing Address - Country:US
Mailing Address - Phone:770-735-3858
Mailing Address - Fax:
Practice Address - Street 1:140 WOODSTOCK SQUARE AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6500
Practice Address - Country:US
Practice Address - Phone:678-445-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002098152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist