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General NPI Number Information
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NPI Number | 1588750194
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Entity Type | Individual
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Provider Name | LESLIE KLIETHERMES O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 8861 DAVIS BLVD STE 102
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City | KELLER
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State | TX
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Zip | 76248-0326
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Country | US
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Telephone | 817-562-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 705 NORTHERN TRCE
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City | KELLER
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State | TX
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Zip | 76248-8729
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Country | US
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Telephone | 254-423-0536
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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 | 05575T
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License Number State | TX
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