MEDICARE: LESLIE E ODELL 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	OEG001304	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1432309	OTHER	PA	BLUE SHIELD
2	50034412	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1922009745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE E ODELL OD

Provider Business Mailing Address
First Line	:	781 FAR HILLS DR STE 100
Second Line	:
City	:	NEW FREEDOM
State	:	PA
Zip	:	17349-8447
Country	:	US
Telephone Number	:	717-759-5929
Fax Number	:	717-563-0348

Provider Business Practice Location Address
First Line	:	781 FAR HILLS DR STE 100
Second Line	:
City	:	NEW FREEDOM
State	:	PA
Zip	:	17349-8447
Country	:	US
Telephone Number	:	717-759-5929
Fax Number	:	717-563-0348

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	04/06/2022

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Directions to “ LESLIE E ODELL OD” Practice Location

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