Provider Demographics
NPI:1134145030
Name:DELEMEESTER, LESLIE K (OD)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:K
Last Name:DELEMEESTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6755 S HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MI
Mailing Address - Zip Code:48655-8710
Mailing Address - Country:US
Mailing Address - Phone:989-642-2429
Mailing Address - Fax:
Practice Address - Street 1:4100 EAST WILDER RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:269-349-7627
Practice Address - Fax:269-342-4284
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003622152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN34040077Medicare PIN
U56772Medicare UPIN