Provider Demographics
NPI:1679670657
Name:LEKITES, CHARLES A (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:LEKITES
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 1:11005 STEEPLE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7122
Mailing Address - Country:US
Mailing Address - Phone:907-696-2030
Mailing Address - Fax:
Practice Address - Street 1:3101 A ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4008
Practice Address - Country:US
Practice Address - Phone:907-569-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
911796094OtherEIN - FEDERAL
AKU47161Medicare UPIN