Provider Demographics
NPI:1659603546
Name:DAVIS, LESA D (OD)
Entity Type:Individual
Prefix:DR
First Name:LESA
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3962 BLUE DIAMOND RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7795
Mailing Address - Country:US
Mailing Address - Phone:702-791-6860
Mailing Address - Fax:702-791-7028
Practice Address - Street 1:3962 BLUE DIAMOND RD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7795
Practice Address - Country:US
Practice Address - Phone:702-791-6860
Practice Address - Fax:702-791-7028
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV418152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist