Provider Demographics
NPI:1649344599
Name:DUNN, LESLIE T (OD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:T
Last Name:DUNN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:DUNN
Other - Last Name:NIEANBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:3732 CREEKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1363
Mailing Address - Country:US
Mailing Address - Phone:335-793-5904
Mailing Address - Fax:336-768-7637
Practice Address - Street 1:800 S STRATFORD RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3202
Practice Address - Country:US
Practice Address - Phone:336-765-5788
Practice Address - Fax:336-765-5584
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89O93G1Medicaid
NCNCF422BMedicare PIN
NCU86874Medicare UPIN