Provider Demographics
NPI:1700110210
Name:GRIFFITH, LESLIE J (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:J
Last Name:GRIFFITH
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 1:1737 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2437
Mailing Address - Country:US
Mailing Address - Phone:707-226-5446
Mailing Address - Fax:707-226-3772
Practice Address - Street 1:1737 1ST ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2437
Practice Address - Country:US
Practice Address - Phone:707-226-5446
Practice Address - Fax:707-226-3772
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10586152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist