Provider Demographics
NPI:1487769030
Name:DEMERS, LESLIE LYNNE (OD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:LYNNE
Last Name:DEMERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:LYNNE
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:670 N MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4600
Mailing Address - Country:US
Mailing Address - Phone:775-358-1317
Mailing Address - Fax:775-355-7522
Practice Address - Street 1:670 N MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4600
Practice Address - Country:US
Practice Address - Phone:775-358-1317
Practice Address - Fax:775-355-7522
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV556152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1487769030Medicaid
NV1487769030OtherNPI
NV1649388794OtherBILLING NPI
NV1487769030Medicaid
NV1649388794OtherBILLING NPI