Provider Demographics
NPI:1255748877
Name:FAULKNER, LESLIE (OD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:FAULKNER
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 1:311 SE DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3631
Mailing Address - Country:US
Mailing Address - Phone:918-336-0607
Mailing Address - Fax:
Practice Address - Street 1:311 SE DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3631
Practice Address - Country:US
Practice Address - Phone:918-336-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2810152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist