Healthcare Provider Details

I. General information

NPI: 1578781134
Provider Name (Legal Business Name): ERIC W. LESER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23161 VENTURA BLVD SUITE 201
WOODLAND HILLS CA
91364-1105
US

IV. Provider business mailing address

23161 VENTURA BLVD SUITE 201
WOODLAND HILLS CA
91364-1105
US

V. Phone/Fax

Practice location:
  • Phone: 818-591-8860
  • Fax:
Mailing address:
  • Phone: 818-591-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP9289T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOP9289T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: