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General NPI Number Information
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NPI Number | 1851932826
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Entity Type | Individual
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Provider Name | LESLIE KOO OD
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Gender | Female
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Dates
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Enumeration Date | 10/01/2019
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 131 BUCCOO ROAD
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City | MT. PLEASANT
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State | TRINIDAD AND TOBAGO
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Zip | 00000
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Country | TT
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Telephone | 868-631-1180
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 209.
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City | SCARBOROUGH
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State | TRINIDAD AND TOBAGO
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Zip | 00000
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Country | TT
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Telephone |
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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 | 3519
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License Number State | MA
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