Healthcare Provider Details

I. General information

NPI: 1235152224
Provider Name (Legal Business Name): KASSON EYE CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
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 Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINE A LESKA
Title or Position: OWNER CEO
Credential: OD
Phone: 507-634-4445