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General NPI Number Information
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NPI Number | 1073406369
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Entity Type | Individual
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Provider Name | ANNIKA LESSARD OD
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Gender | Female
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 4270 N EAGLE RD
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City | BOISE
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State | ID
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Zip | 83713-0726
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Country | US
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Telephone | 208-938-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 9887 W CAROLINA DR
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City | BOISE
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State | ID
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Zip | 83709-2696
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Country | US
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Telephone | 707-712-9087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5171668
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License Number State | ID
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