Provider Demographics
NPI:1457108516
Name:LESLIE, MOLLY KAY (OD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:KAY
Last Name:LESLIE
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 1:1541 NUNAMAKER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-6667
Mailing Address - Country:US
Mailing Address - Phone:989-745-4497
Mailing Address - Fax:
Practice Address - Street 1:1920 PICKENS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2632
Practice Address - Country:US
Practice Address - Phone:803-779-3070
Practice Address - Fax:803-771-7639
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2479152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program