MEDICARE: LESLI DIANE HANDMACHER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5867	CA

General Provider Information

NPI Number	:	1245359090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLI DIANE HANDMACHER O.D.

Provider Business Mailing Address
First Line	:	1508 WALNUT ST STE D
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94709-1564
Country	:	US
Telephone Number	:	510-540-5555
Fax Number	:	510-548-3999

Provider Business Practice Location Address
First Line	:	1508 WALNUT ST STE D
Second Line	:	WALNUT SQUARE
City	:	BERKELEY
State	:	CA
Zip	:	94709-1564
Country	:	US
Telephone Number	:	510-540-5555
Fax Number	:	510-548-3999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	02/20/2009

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