Healthcare Provider Details

I. General information

NPI: 1073406369
Provider Name (Legal Business Name): ANNIKA LESSARD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 E AMITY RD
MERIDIAN ID
83642-8380
US

IV. Provider business mailing address

9887 W CAROLINA DR
BOISE ID
83709-2696
US

V. Phone/Fax

Practice location:
  • Phone: 208-370-2020
  • Fax: 208-600-6899
Mailing address:
  • Phone: 707-712-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5171668
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: