Provider Demographics
NPI:1871762963
Name:REEVES, LESLIE (OD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:REEVES
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 1:400 BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-3813
Mailing Address - Country:US
Mailing Address - Phone:501-847-6677
Mailing Address - Fax:501-847-6372
Practice Address - Street 1:400 BRYANT AVE
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3813
Practice Address - Country:US
Practice Address - Phone:501-847-6677
Practice Address - Fax:501-847-6372
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2606152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist