Provider Demographics
NPI:1790709699
Name:LESSLY, MICHAEL GUYTON (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GUYTON
Last Name:LESSLY
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:103 S US HIGHWAY 1
Mailing Address - Street 2:B-2
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5132
Mailing Address - Country:US
Mailing Address - Phone:561-685-8177
Mailing Address - Fax:561-746-3268
Practice Address - Street 1:103 S US HIGHWAY 1
Practice Address - Street 2:B-2
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5132
Practice Address - Country:US
Practice Address - Phone:561-685-8177
Practice Address - Fax:561-746-3268
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2020-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC 3355152WP0200X, 152WC0802X, 152WL0500X, 152W00000X, 152WV0400X, 152WV0400X
VA0618001596152WC0802X, 152WL0500X, 152WV0400X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00X217M01Medicare PIN