Healthcare Provider Details

I. General information

NPI: 1457595399
Provider Name (Legal Business Name): LESLIE WEI PATCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE ANN WEI M.D.

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JACKSON PIKE
GALLIPOLIS OH
45631
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1562
US

V. Phone/Fax

Practice location:
  • Phone: 855-446-5937
  • Fax: 740-446-8683
Mailing address:
  • Phone: 740-441-1949
  • Fax: 740-446-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number279820
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number279820
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number279820
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.132596
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: