Provider Demographics
NPI:1457416380
Name:BRANIN, LESLIE (OD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BRANIN
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 1:6030 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4808
Mailing Address - Country:US
Mailing Address - Phone:727-547-4856
Mailing Address - Fax:727-548-1647
Practice Address - Street 1:4466 PARK BLVD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3539
Practice Address - Country:US
Practice Address - Phone:727-547-4856
Practice Address - Fax:727-548-1647
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU09416Medicare UPIN
FL20202AMedicare ID - Type Unspecified