Individual
LESLIE D THORNBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
W7164 GREEN VALLEY RD, INDIANHEAD EYE CLINIC, SPOONER, WI 54801-6605
(715) 635-3127
(715) 635-3316
Mailing address
PO BOX 446, SPOONER, WI 54801-0446
(715) 635-3127
(715) 635-3316
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1515035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38561400
—
WI
01
—
410028270
PALMETTO RR MEDICARE
—
Enumeration date
11/15/2005
Last updated
01/24/2014
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