Provider Demographics
NPI:1396968327
Name:ANDERSON, LESLIE MCEWEN (OD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:MCEWEN
Last Name:ANDERSON
Suffix:
Gender:M
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:PO BOX 23176
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-0274
Mailing Address - Country:US
Mailing Address - Phone:704-545-8831
Mailing Address - Fax:704-545-2354
Practice Address - Street 1:11235 LAWYERS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-9355
Practice Address - Country:US
Practice Address - Phone:704-545-8831
Practice Address - Fax:704-545-2354
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1078152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909027Medicaid
NC0648710001Medicare NSC
NC8909027Medicaid
T64948Medicare UPIN