MEDICARE: DR. LESLIE M GARCIA 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	359	PR
2	152W00000X	Optometrist	0130	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	890315	OTHER		MEDICARE Y MUCHO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	7830009	OTHER	HUMANA INSURANCE CO
3	7830009	OTHER	HUMANA HEALTH PLANS
4	05068	OTHER	DENIS VISION
5	58113GA	OTHER	TRIPLE-S
6	6874	OTHER	INTERNATIONAL MEDICAL CAR
7	051681	OTHER	CRUZ AZUL DE PR
8	23405	OTHER	PROSSAM

General Provider Information

NPI Number	:	1093706673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE M GARCIA OD

Provider Business Mailing Address
First Line	:	CALLE BALDORIOTY NORTE #165
Second Line	:	EDIFICIO CENTRAL STE 4
City	:	AIBONITO
State	:	PR
Zip	:	00705
Country	:	US
Telephone Number	:	787-735-1974
Fax Number	:	787-735-1974

Provider Business Practice Location Address
First Line	:	CALLE BALDORIOTY NORTE #165
Second Line	:	EDIFICIO CENTRAL STE 4
City	:	AIBONITO
State	:	PR
Zip	:	00705
Country	:	US
Telephone Number	:	787-735-1974
Fax Number	:	787-735-1974

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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