Provider Demographics
NPI:1912046426
Name:LAI, LESLIE Y (OD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:Y
Last Name:LAI
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 1:40 MOTT ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5011
Mailing Address - Country:US
Mailing Address - Phone:212-267-1260
Mailing Address - Fax:212-385-8308
Practice Address - Street 1:40 MOTT ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5011
Practice Address - Country:US
Practice Address - Phone:212-267-1260
Practice Address - Fax:212-385-8308
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003763152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY 01631034Medicaid