Individual
LESLIE SIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
808 N KENTUCKY AVE, WEST PLAINS, MO 65775-2023
(417) 255-2010
Mailing address
808 N KENTUCKY AVE, WEST PLAINS, MO 65775-2023
(417) 255-2010
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2021023766
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021023766
LICENSE NUMBER
MO
Enumeration date
06/25/2021
Last updated
06/25/2021
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