Individual
DR. LESLIE R MASCIARELLI KISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
918 WASHINGTON AVE, OPTICAL EYEDEAS, DETROIT LAKES, MN 56501
(218) 847-8021
(218) 846-9552
Mailing address
706 12TH ST SE, BARNESVILLE, MN 56514-3960
(218) 354-7065
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2319
MN
152W00000X
Optometrist
490
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2202047
MEDICA
MN
01
—
2202048
MEDICA
MN
01
—
2207652
MEDICA
MN
01
—
283R7MA
BCBS
MN
01
—
283R8MA
BCBS
MN
01
—
36B56MA
BCBS
MN
Enumeration date
09/26/2006
Last updated
07/08/2007
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