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General NPI Number Information
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NPI Number | 1548456064
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Entity Type | Individual
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Provider Name | LESLIE MITCHELL CLARY O. D.
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Gender | Male
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 1425 E 71ST ST
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City | TULSA
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State | OK
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Zip | 74136-5038
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Country | US
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Telephone | 918-446-3171
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Fax | 918-446-5938
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Provider Business Mailing Address
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Address Line | 1425 E 71ST ST
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City | TULSA
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State | OK
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Zip | 74136-5038
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Country | US
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Telephone | 918-446-3171
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Fax | 918-446-5938
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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 | 2516
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License Number State | OK
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