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General NPI Number Information
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NPI Number | 1467421990
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Entity Type | Individual
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Provider Name | HARVEY DENNIS LEDESMA O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4124 N SIERRA WAY
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-3825
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Country | US
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Telephone | 909-883-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 6550 APPLEWOOD ST
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City | HIGHLAND
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State | CA
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Zip | 92346-5210
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Country | US
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Telephone | 909-725-1422
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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 | OPT12094TPL
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License Number State | CA
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