Provider Demographics
NPI:1578690855
Name:LESJAK, THOMAS J (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:LESJAK
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 1:10521 S PARKER RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9082
Mailing Address - Country:US
Mailing Address - Phone:303-841-8243
Mailing Address - Fax:303-841-3752
Practice Address - Street 1:10521 S PARKER RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9082
Practice Address - Country:US
Practice Address - Phone:303-841-8243
Practice Address - Fax:303-841-3752
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO410012223OtherRAILROAD MEDICARE PIN
COC443648Medicare ID - Type Unspecified
CO410012223OtherRAILROAD MEDICARE PIN