Provider Demographics
NPI:1841590379
Name:ERIC W LESER OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ERIC W LESER OD A PROFESSIONAL CORPORATION
Other - Org Name:GRANADA HILLS OPTOMETRY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:LESER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-366-2020
Mailing Address - Street 1:18013 CHATSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5608
Mailing Address - Country:US
Mailing Address - Phone:818-366-2020
Mailing Address - Fax:818-366-9868
Practice Address - Street 1:18013 CHATSWORTH ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5608
Practice Address - Country:US
Practice Address - Phone:818-366-2020
Practice Address - Fax:818-366-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP9289T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFA701AMedicare PIN