Provider Demographics
NPI:1467482141
Name:LESSARD, PAUL ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ARTHUR
Last Name:LESSARD
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 1:7511 FOLK WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-5016
Mailing Address - Country:US
Mailing Address - Phone:863-853-1132
Mailing Address - Fax:863-853-1132
Practice Address - Street 1:3730 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3809
Practice Address - Country:US
Practice Address - Phone:863-853-9606
Practice Address - Fax:863-853-9344
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1849152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT93905Medicare UPIN
FL19446YMedicare ID - Type Unspecified