MEDICARE: ERISALDI LEKURA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901005182	MI

General Provider Information

NPI Number	:	1093273856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERISALDI LEKURA

Provider Business Mailing Address
First Line	:	31020 JOHN R RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1908
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31020 JOHN R RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1908
Country	:	US
Telephone Number	:	248-589-1349
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2019
Last Update Date	:	03/11/2019

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Directions to “ ERISALDI LEKURA ” Practice Location

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