Basic Information
| Provider Information | |||||||||
| NPI: | 1134145030 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELEMEESTER | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6755 S HEMLOCK RD | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486558710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896422429 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4100 EAST WILDER RD | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693497627 | ||||||||
| FaxNumber: | 2693424284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 03/17/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901003622 | MI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.