Individual
DR. LESLIE ALLYSON HACKWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
HWY 86, MILE MARKER 74, EYE CLINIC, SAN SIMON INDIAN HEALTH CENTER, N/A, AZ 85634-9716
(520) 235-0344
(520) 362-7080
Mailing address
HC01 BOX 8150, SAN SIMON INDIAN HEALTH CENTER, SELLS, AZ 85634-9737
(520) 235-0344
(520) 363-7080
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002586
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004237097
—
CT
Enumeration date
12/15/2006
Last updated
08/02/2012
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