Individual provider Active NPI

Leslie A. Sciumbato, O.D.

  • Optometrist
  • Amarillo, TX
National Provider Identifier
1790941185
Registry record updated Mar 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7294T Issued in TX
Practice address
3635 S Soncy Rd
Amarillo, TX 79119-6402
Phone
(806) 356-6868
Fax
(806) 351-0120
NPI assigned
Aug 5, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 24, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 7294T TX Primary

Addresses

Primary practice location

3635 S Soncy Rd
Amarillo, TX 79119-6402

Mailing address

3635 S Soncy Rd
Amarillo, TX 79119-6402
Phone (806) 356-6868

Other identifiers 1

IdentifierTypeStateIssuer
1790941185OtherTXNPI

Other names 1

  • Dr. Leslie Banks Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090514000131 TX Practitioner - Optometry 0840349254 Reassigns benefits to 1 organization
Practice locations: Amarillo, TX

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Med Southwest PLLCGroup PAC ID 4082952874, 234 clinicians

Practice addresses (Care Compare)

3104 Indiana Ave
Lubbock, TX 79410-3148
Phone (806) 793-1927

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7294TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Med Southwest, PLLC Optometrist CurrentSince Aug 8, 2022 Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Aug 8, 2022 Accepting new patients
Med Southwest, PLLC Optometrist Current Accepting new patients
Silver Spring Optometry, LLC Optometrist Past Accepting new patients

Locations

3635 S Soncy Rd
Amarillo, TX 79119
Phone (806) 356-6868

3104 Indiana Ave
Lubbock, TX 79410
Phone (803) 793-1927

2703 Richmond Rd
Texarkana, TX 75503
Phone (903) 838-0783

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395619200000",
    "number": "1790941185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3635 S SONCY RD",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791196402",
            "telephone_number": "806-356-6868",
            "fax_number": "806-351-0120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3635 S SONCY RD",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791196402",
            "telephone_number": "806-356-6868",
            "fax_number": "806-351-0120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCIUMBATO",
        "first_name": "LESLIE",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-05",
        "last_updated": "2014-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7294T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1790941185",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LESLIE",
            "last_name": "BANKS",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Amarillo, TX

Sources for this page

Verify at the official NPI Registry.