Provider Demographics
NPI:1306884200
Name:LESKO, ROBERT E (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:LESKO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N DIXON RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4154
Mailing Address - Country:US
Mailing Address - Phone:765-459-3937
Mailing Address - Fax:765-459-4430
Practice Address - Street 1:104 N DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4154
Practice Address - Country:US
Practice Address - Phone:765-459-3937
Practice Address - Fax:765-459-4430
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200076890Medicaid
IN365170GMedicare ID - Type Unspecified
IN200076890Medicaid