Provider Demographics
NPI:1528529542
Name:LASECKI, CHRISTOPHER HENRY (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:HENRY
Last Name:LASECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5185 PEACHTREE PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-6545
Mailing Address - Country:US
Mailing Address - Phone:251-554-4278
Mailing Address - Fax:
Practice Address - Street 1:5185 PEACHTREE PKWY STE 350
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-6545
Practice Address - Country:US
Practice Address - Phone:770-858-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA99068207WX0110X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program