Provider Demographics
NPI:1083629943
Name:LESSARD, GUY (O,D)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:
Last Name:LESSARD
Suffix:
Gender:M
Credentials:O,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 S WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-5728
Mailing Address - Country:US
Mailing Address - Phone:603-625-1774
Mailing Address - Fax:603-624-1530
Practice Address - Street 1:345 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5728
Practice Address - Country:US
Practice Address - Phone:603-625-1774
Practice Address - Fax:603-624-1530
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH578152W00000X
MA3646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH446392Medicare UPIN
NHLERE2922Medicare ID - Type Unspecified