Individual
LEONARD BRINKLEY WHITESIDE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
12018 W BROAD ST, SUITE 100, HENRICO, VA 23233-7689
(804) 287-1380
(804) 287-1384
Mailing address
400 WESTHAMPTON STA, RICHMOND, VA 23226-3330
(804) 287-4200
(804) 287-4210
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000199
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230283
ANTHEM
VA
Enumeration date
10/10/2006
Last updated
03/22/2012
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