Provider Demographics
NPI:1740470830
Name:LEZONDRA, BEVERLY JANE (OD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:JANE
Last Name:LEZONDRA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15919 SELFRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-7211
Mailing Address - Country:US
Mailing Address - Phone:708-359-5336
Mailing Address - Fax:
Practice Address - Street 1:641 E BOUGHTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3143
Practice Address - Country:US
Practice Address - Phone:630-783-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist