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General NPI Number Information
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NPI Number | 1457488116
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Entity Type | Individual
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Provider Name | LESLIE N. RICHARDSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 725 CAMPBELLSVILLE BYP
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-8846
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Country | US
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Telephone | 270-465-3669
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Fax | 270-789-0584
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Provider Business Mailing Address
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Address Line | 725 CAMPBELLSVILLE BYPASS
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-1596
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Country | US
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Telephone | 270-465-3669
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Fax | 270-789-0584
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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 | 851-DT
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License Number State | KY
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