Individual
DR. LESLIE RAND WILDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1250 BALTIMORE PIKE, PEARLE VISION, SPRINGFIELD, PA 19064-2706
(610) 544-1841
(610) 544-2984
Mailing address
2300 PINE ST, #7, PHILADELPHIA, PA 19103-6438
(215) 490-8090
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OET008830
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
PA
Enumeration date
08/07/2006
Last updated
10/03/2008
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