Provider Demographics
NPI:1205904570
Name:MICHAEL G LESSLY OD PC
Entity type:Organization
Organization Name:MICHAEL G LESSLY OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAGGIULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-685-8177
Mailing Address - Street 1:4207 GERMANNA HWY
Mailing Address - Street 2:C
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-2040
Mailing Address - Country:US
Mailing Address - Phone:561-685-8177
Mailing Address - Fax:540-972-6788
Practice Address - Street 1:4207 GERMANNA HWY
Practice Address - Street 2:C
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-2040
Practice Address - Country:US
Practice Address - Phone:561-685-8177
Practice Address - Fax:540-972-6788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3355152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WV0400X
VA0618001596152WC0802X, 152WL0500X, 152WP0200X, 152WV0400X
VA06180001596152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU86660Medicare UPIN
FLE8285Medicare PIN
VAC09984Medicare PIN