Provider Demographics
NPI:1982786026
Name:FALCON, LESLIE MARIE CUCUZZA (OD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:MARIE CUCUZZA
Last Name:FALCON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:MARIE
Other - Last Name:CUCUZZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1100 S DOBSON RD
Mailing Address - Street 2:STE 103
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6158
Mailing Address - Country:US
Mailing Address - Phone:480-383-9956
Mailing Address - Fax:
Practice Address - Street 1:1100 S DOBSON RD STE 103
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6158
Practice Address - Country:US
Practice Address - Phone:480-857-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWDBTZMedicare PIN
V07939Medicare UPIN