Provider Demographics
NPI:1356451108
Name:LESSER, LAURIE ROBIN (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ROBIN
Last Name:LESSER
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 1:51 GABLES BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2590
Mailing Address - Country:US
Mailing Address - Phone:954-389-7233
Mailing Address - Fax:
Practice Address - Street 1:12538 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1713
Practice Address - Country:US
Practice Address - Phone:954-430-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2591152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620078800Medicaid
FL620078800Medicaid
FL20550Medicare ID - Type UnspecifiedMEDICARE PART B