MEDICARE: DR. LESLIE A DRAPER OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OD2640	TN
2	152W00000X	Optometrist	OPC4017	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083713622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE A DRAPER OD

Provider Business Mailing Address
First Line	:	511 SE 5TH AVE APT 819
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2969
Country	:	US
Telephone Number	:	423-883-2535
Fax Number	:

Provider Business Practice Location Address
First Line	:	2583 E SUNRISE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3203
Country	:	US
Telephone Number	:	954-563-8288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	04/01/2020

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