Individual
LESLIE BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5171 KINGS PLZ, BROOKLYN, NY 11234-5218
(718) 951-9800
Mailing address
5171 KINGS PLZ, BROOKLYN, NY 11234-5218
(718) 951-9800
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
NY2877
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01283476
—
NY
Enumeration date
03/21/2007
Last updated
01/07/2013
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