Provider Demographics
NPI:1538257373
Name:SCHEETZ, LESLIE S (OD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:S
Last Name:SCHEETZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3478 KENSINGTON PARC CIR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1779
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2050 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE D-50
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4323
Practice Address - Country:US
Practice Address - Phone:404-325-5300
Practice Address - Fax:404-636-5959
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist