Provider Demographics
NPI:1871721910
Name:KIRK, LESLIE ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ELIZABETH
Last Name:KIRK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:ELIZABETH
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2362 STEVENSON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-7138
Mailing Address - Country:US
Mailing Address - Phone:843-513-8722
Mailing Address - Fax:843-501-7236
Practice Address - Street 1:3525 PARK AVENUE BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466
Practice Address - Country:US
Practice Address - Phone:843-375-7036
Practice Address - Fax:843-375-7037
Is Sole Proprietor?:No
Enumeration Date:2009-06-28
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist