Healthcare Provider Details

I. General information

NPI: 1609368885
Provider Name (Legal Business Name): LEZAMA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 TAMIAMI TRL N STE 8
NAPLES FL
34110-6221
US

IV. Provider business mailing address

14700 TAMIAMI TRL N STE 8
NAPLES FL
34110-6221
US

V. Phone/Fax

Practice location:
  • Phone: 239-374-2075
  • Fax:
Mailing address:
  • Phone: 239-374-2075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4214
License Number StateFL

VIII. Authorized Official

Name: EMILIO MARTINEZ-LEZAMA
Title or Position: OWNER/OD
Credential: OD
Phone: 901-289-1877