Provider Demographics
NPI:1407316102
Name:LESOLTIS, NGUYET THAI (OD)
Entity Type:Individual
Prefix:
First Name:NGUYET
Middle Name:THAI
Last Name:LESOLTIS
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 1:1815 MASSACHUSETTS AVE STE 117B
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1430
Mailing Address - Country:US
Mailing Address - Phone:857-600-0701
Mailing Address - Fax:617-453-9369
Practice Address - Street 1:1815 MASSACHUSETTS AVE STE 117B
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1430
Practice Address - Country:US
Practice Address - Phone:857-600-0701
Practice Address - Fax:617-453-9369
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008854152W00000X
MA5336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist