Provider Demographics
NPI:1750518825
Name:DENNIS-MAHAMED, LESA (OD)
Entity type:Individual
Prefix:DR
First Name:LESA
Middle Name:
Last Name:DENNIS-MAHAMED
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3221
Mailing Address - Country:US
Mailing Address - Phone:781-725-2020
Mailing Address - Fax:
Practice Address - Street 1:2304 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-3221
Practice Address - Country:US
Practice Address - Phone:781-725-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4734152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist