Provider Demographics
NPI:1972812428
Name:MICHAEL LESSLY OD PA
Entity Type:Organization
Organization Name:MICHAEL LESSLY OD PA
Other - Org Name:INLET OPTICAL EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGGIULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-685-8177
Mailing Address - Street 1:103 S US HIGHWAY 1
Mailing Address - Street 2:UNIT #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:UNIT #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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3355152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8860624Medicaid
FLE8285Medicare PIN