Healthcare Provider Details

I. General information

NPI: 1487769030
Provider Name (Legal Business Name): LESLIE LYNNE DEMERS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESLIE LYNNE HANSON O.D.

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 N MCCARRAN BLVD
SPARKS NV
89431-4600
US

IV. Provider business mailing address

670 N MCCARRAN BLVD
SPARKS NV
89431-4600
US

V. Phone/Fax

Practice location:
  • Phone: 775-358-1317
  • Fax: 775-355-7522
Mailing address:
  • Phone: 775-358-1317
  • Fax: 775-355-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number556
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: