Provider Demographics
NPI:1104098045
Name:BROOKS, LESLEY N (OD)
Entity type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:N
Last Name:BROOKS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825-B MERRIMON AVE.
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804
Mailing Address - Country:US
Mailing Address - Phone:828-236-0099
Mailing Address - Fax:828-236-1236
Practice Address - Street 1:825-B MERRIMON AVE.
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804
Practice Address - Country:US
Practice Address - Phone:828-236-0099
Practice Address - Fax:828-236-1236
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2080152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909234Medicaid
NC2473154Medicare PIN