Provider Demographics
NPI:1346622255
Name:DE MEL, LAKSIRI F (OD)
Entity Type:Individual
Prefix:DR
First Name:LAKSIRI
Middle Name:F
Last Name:DE MEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7316 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4715
Mailing Address - Country:US
Mailing Address - Phone:480-703-2054
Mailing Address - Fax:
Practice Address - Street 1:4528 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7610
Practice Address - Country:US
Practice Address - Phone:602-273-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist