Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 34729 | CA |
NPI | 1003410234 |
---|---|
Provider Name | Leslie A. Bacani |
First Address | Fresno, CA 93720-5380 |
Second Address | Clovis, CA 93612-3915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2020 |
Last Update Date | 29/11/2020 |