Provider Demographics
NPI:1851420590
Name:HERRO, LESTER JOSEPH JR (OD)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:JOSEPH
Last Name:HERRO
Suffix:JR
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 1:5026 SO ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-4990
Mailing Address - Country:US
Mailing Address - Phone:773-434-6228
Mailing Address - Fax:773-434-7889
Practice Address - Street 1:5026 SO ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-4990
Practice Address - Country:US
Practice Address - Phone:773-434-6228
Practice Address - Fax:773-434-7889
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006858152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046006858Medicaid
IL510860Medicare ID - Type Unspecified
IL046006858Medicaid