Provider Demographics
NPI:1124348552
Name:LESLIE HUEY, O.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LESLIE HUEY, O.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-320-0081
Mailing Address - Street 1:2396 CRENSHAW BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3336
Mailing Address - Country:US
Mailing Address - Phone:310-320-0081
Mailing Address - Fax:310-320-0082
Practice Address - Street 1:2396 CRENSHAW BLVD STE C
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3336
Practice Address - Country:US
Practice Address - Phone:310-320-0081
Practice Address - Fax:310-320-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5698T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEO196AMedicare PIN