Individual
LEONARD BRINKLEY WHITESIDE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
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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