Provider Demographics
NPI:1578887485
Name:LESLIE DRAPER OD PC
Entity type:Organization
Organization Name:LESLIE DRAPER OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-468-3305
Mailing Address - Street 1:915 MIDDLE RIVER DR STE 420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3561
Mailing Address - Country:US
Mailing Address - Phone:954-372-6822
Mailing Address - Fax:954-372-6838
Practice Address - Street 1:915 MIDDLE RIVER DR STE 420
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3561
Practice Address - Country:US
Practice Address - Phone:954-372-6822
Practice Address - Fax:954-372-6838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125813400Medicaid
TN103G414892Medicare PIN
TN3590042Medicaid