Provider Demographics
NPI:1831281880
Name:LESUEUR, BRANDON G (OD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:G
Last Name:LESUEUR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:845 TWELVE BRIDGES DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8819
Mailing Address - Country:US
Mailing Address - Phone:916-645-3937
Mailing Address - Fax:
Practice Address - Street 1:845 TWELVE BRIDGES DR
Practice Address - Street 2:STE 130
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-8819
Practice Address - Country:US
Practice Address - Phone:916-231-0034
Practice Address - Fax:916-231-0038
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA10061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10061OtherLICENSE NUMBER
CA10061OtherLICENSE NUMBER