Individual
LESLIE DEHAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
122 HIGHWAY 76, WHITE HOUSE, TN 37188-9291
(615) 672-6896
(615) 672-6783
Mailing address
122 HIGHWAY 76, WHITE HOUSE, TN 37188-9291
(615) 672-6896
(615) 672-6783
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1510DT
KY
152W00000X
Optometrist
Primary
2276
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3944682
—
TN
Enumeration date
12/21/2006
Last updated
05/02/2013
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