Healthcare Provider Details

I. General information

NPI: 1154391159
Provider Name (Legal Business Name): ROBERT L. LESSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WEST MAIN STREET SUITE 100
WATERBURY CT
06708
US

IV. Provider business mailing address

1201 WEST MAIN STREET SUITE 100
WATERBURY CT
06708
US

V. Phone/Fax

Practice location:
  • Phone: 203-597-9100
  • Fax: 203-596-4758
Mailing address:
  • Phone: 203-597-9100
  • Fax: 203-596-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number014951
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number014951
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: