Provider Demographics
NPI:1356674873
Name:LESCO OPTICAL
Entity Type:Organization
Organization Name:LESCO OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:GUAYANTE
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:520-323-6513
Mailing Address - Street 1:4444 E GRANT RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2696
Mailing Address - Country:US
Mailing Address - Phone:520-323-6513
Mailing Address - Fax:520-323-9141
Practice Address - Street 1:4444 E GRANT RD
Practice Address - Street 2:SUITE 118
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2696
Practice Address - Country:US
Practice Address - Phone:520-323-6513
Practice Address - Fax:520-323-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2033I156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty