Provider Demographics
NPI:1083651137
Name:BRACKLEY, LESTER M (OD)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:M
Last Name:BRACKLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:LESTER
Other - Middle Name:MILTON
Other - Last Name:BRACKLEY
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:C/O EMPIRE VISION CENTER, INC
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1430
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:1 SCAMMELL ST
Practice Address - Street 2:MASS OPTOMETRIC ASSOCIATES, P. C.
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6706
Practice Address - Country:US
Practice Address - Phone:617-773-1353
Practice Address - Fax:617-773-1309
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0399566Medicaid
T59341Medicare UPIN
MA207358Medicare ID - Type Unspecified