Healthcare Provider Details

I. General information

NPI: 1427997725
Provider Name (Legal Business Name): LESLIEANN BOUCAUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SANFORD FARMS SHOPPING CTR
AMSTERDAM NY
12010-7538
US

IV. Provider business mailing address

101 SANFORD FARMS SHOPPING CTR
AMSTERDAM NY
12010-7538
US

V. Phone/Fax

Practice location:
  • Phone: 518-843-0189
  • Fax: 518-843-0460
Mailing address:
  • Phone: 518-843-0189
  • Fax: 518-843-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number010763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: