Healthcare Provider Details

I. General information

NPI: 1225064843
Provider Name (Legal Business Name): CHRISTINE A LESKA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 S MANTORVILLE AVENUE STE 1
KASSON MN
55944-2207
US

IV. Provider business mailing address

504 S MANTORVILLE AVENUE STE 1
KASSON MN
55944-2207
US

V. Phone/Fax

Practice location:
  • Phone: 507-634-4445
  • Fax: 507-634-7940
Mailing address:
  • Phone: 507-634-4445
  • Fax: 507-634-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1806
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: