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Individual
STEPHANIE KIM LESAGE
Active
Individual
STEPHANIE KIM LESAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1658-692T
LA
152W00000X
Optometrist
5043
MA
152W00000X
Optometrist
Primary
8268-T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01102701
—
LA
05
—
2342797
—
LA
Enumeration date
07/08/2013
Last updated
10/26/2023
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