1528490083 NPI number — DR. RAYMOND M LESTER OD

Table of content: DR. RAYMOND M LESTER OD (NPI 1528490083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528490083 NPI number — DR. RAYMOND M LESTER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LESTER
Provider First Name:
RAYMOND
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528490083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 N WINTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14610-1236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-586-6524
Provider Business Mailing Address Fax Number:
585-586-9719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1671 PENFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14625-2568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-586-6524
Provider Business Practice Location Address Fax Number:
585-586-9719
Provider Enumeration Date:
08/06/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TUV007974 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)