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General NPI Number Information
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NPI Number | 1255378998
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Entity Type | Individual
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Provider Name | LESLIE JOAN HUMPHREY O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 1756 W LANE AVE
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City | COLUMBUS
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State | OH
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Zip | 43221-3311
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Country | US
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Telephone | 614-488-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 1108 BAUMOCK BURN DR
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City | COLUMBUS
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State | OH
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Zip | 43235-2166
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Country | US
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Telephone | 614-310-5480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5314/T2223
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License Number State | OH
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