Provider Demographics
NPI:1659302313
Name:DRS. CONVERSE & LESSARD, P.A.
Entity Type:Organization
Organization Name:DRS. CONVERSE & LESSARD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:863-853-1132
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 1:7511 FOLK WAY
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-5016
Practice Address - Country:US
Practice Address - Phone:863-853-1132
Practice Address - Fax:863-853-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1318Medicare ID - Type Unspecified