Provider Demographics
NPI:1124578596
Name:LESKA TRADING COMPANY, INC
Entity Type:Organization
Organization Name:LESKA TRADING COMPANY, INC
Other - Org Name:LESKA OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:PERAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-605-3508
Mailing Address - Street 1:1101 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912
Mailing Address - Country:US
Mailing Address - Phone:301-439-1796
Mailing Address - Fax:
Practice Address - Street 1:1101 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7444
Practice Address - Country:US
Practice Address - Phone:301-439-1796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2284305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service