Individual
DR. LESLIE W WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
126 S HIGHLAND AVE, CUSHING, OK 74023-4115
(918) 225-1548
(918) 225-1548
Mailing address
PO BOX 670, CUSHING, OK 74023-0670
(918) 225-1548
(918) 225-1548
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
872
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100762540 A
—
OK
01
—
731001801
FEDERAL TAX ID
OK
Enumeration date
08/31/2006
Last updated
08/12/2009
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