Individual
LESLIE GAUNTLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
180 W GIRARD AVE STE 5, PHILADELPHIA, PA 19123-1660
(215) 554-6222
Mailing address
180 W GIRARD AVE STE 5, PHILADELPHIA, PA 19123-1660
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
008856
NY
152W00000X
Optometrist
Primary
OEG003712
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103831526
—
PA
Enumeration date
08/01/2018
Last updated
06/19/2021
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