Individual
LESLIE R ALONZO III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
403 VONDERBURG DR, STE 101, BRANDON, FL 33511-5982
(813) 681-1122
(813) 684-4924
Mailing address
403 VONDERBURG DR, BRANDON, FL 33511-5982
(813) 681-1122
(813) 684-4924
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC2323
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078635700
—
FL
01
—
19254
BCBS FLORIDA
FL
01
—
2074336
AETNA
FL
01
—
4388598
AETNA
FL
01
—
6500152
GHI
FL
Enumeration date
07/07/2005
Last updated
09/11/2020
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