Provider Demographics
NPI:1164791919
Name:JONES, LEZLIE PEARL (OD)
Entity Type:Individual
Prefix:DR
First Name:LEZLIE
Middle Name:PEARL
Last Name:JONES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LEZLIE
Other - Middle Name:PEARL
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:702 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2767
Mailing Address - Country:US
Mailing Address - Phone:507-376-5535
Mailing Address - Fax:
Practice Address - Street 1:702 10TH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2767
Practice Address - Country:US
Practice Address - Phone:507-376-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002535152W00000X
MN3407152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist