Provider Demographics
NPI:1831248483
Name:LESSCO, INC.
Entity type:Organization
Organization Name:LESSCO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MAIZE
Authorized Official - Last Name:LESSLIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-747-7663
Mailing Address - Street 1:1370 REMOUNT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-3322
Mailing Address - Country:US
Mailing Address - Phone:843-747-7663
Mailing Address - Fax:843-747-7665
Practice Address - Street 1:1370 REMOUNT RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-3322
Practice Address - Country:US
Practice Address - Phone:843-747-7663
Practice Address - Fax:843-747-7665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9770Medicaid
SCD11315Medicaid
SC4766260001Medicare NSC
SC7214Medicare PIN
SCU792387214Medicare UPIN