MEDICARE: DR. ROBERT L. LESSER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	014951	CT
2	207WX0109X	Neuro-ophthalmology Physician	014951	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180000154	OTHER	CT	MEDICARE PTAN

General Provider Information

NPI Number	:	1154391159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L. LESSER M.D.

Provider Business Mailing Address
First Line	:	1201 WEST MAIN STREET
Second Line	:	SUITE 100
City	:	WATERBURY
State	:	CT
Zip	:	06708
Country	:	US
Telephone Number	:	203-597-9100
Fax Number	:	203-596-4758

Provider Business Practice Location Address
First Line	:	1201 WEST MAIN STREET
Second Line	:	SUITE 100
City	:	WATERBURY
State	:	CT
Zip	:	06708
Country	:	US
Telephone Number	:	203-597-9100
Fax Number	:	203-596-4758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	12/12/2017

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