Provider Demographics
NPI:1154392868
Name:YORK, LESLIE BRIAN (OD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:BRIAN
Last Name:YORK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8138 FATHERSON CIRCLE
Mailing Address - Street 2:P.O. BOX 1401
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315
Mailing Address - Country:US
Mailing Address - Phone:423-827-4243
Mailing Address - Fax:
Practice Address - Street 1:8138 FATHERSON CIR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6496
Practice Address - Country:US
Practice Address - Phone:423-827-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2184152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU90900Medicare UPIN