Provider Demographics
NPI:1609368885
Name:LEZAMA, P.A.
Entity Type:Organization
Organization Name:LEZAMA, P.A.
Other - Org Name:EVERGLADES EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ-LEZAMA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-289-1877
Mailing Address - Street 1:4652 SIESTA CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8830
Mailing Address - Country:US
Mailing Address - Phone:012-891-8779
Mailing Address - Fax:
Practice Address - Street 1:2324 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2003
Practice Address - Country:US
Practice Address - Phone:239-403-7037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4214152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty