Leslie R Masciarelli Kisch, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2319 Issued in MN

Practice address

918 Washington Ave
Optical Eyedeas
Detroit Lakes, MN 56501

Phone

(218) 847-8021

Fax

(218) 846-9552

NPI assigned

Sep 26, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 6

Other names 1

• Dr. Leslie R Masciarelli Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Richard N Kittelson

  dba Optical Eyedeas

  • Optician
  • Detroit Lakes, MN
  • NPI 1962496570

  Optometrist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699876417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 12TH ST SE",
            "city": "BARNESVILLE",
            "state": "MN",
            "postal_code": "565143960",
            "telephone_number": "218-354-7065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 WASHINGTON AVE",
            "address_2": "OPTICAL EYEDEAS",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "56501",
            "telephone_number": "218-847-8021",
            "fax_number": "218-846-9552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASCIARELLI KISCH",
        "first_name": "LESLIE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2319",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "490",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2207652",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "36B56MA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2202047",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2202048",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "283R7MA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "283R8MA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LESLIE",
            "last_name": "MASCIARELLI",
            "middle_name": "R",
            "prefix": "DR.",
            "credential": "OD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Amy Marchus, PHARM D
• Melanie Markuson, APRN, CNP
• Guillermo Alfredo Marroquin Galvez, M.D.
• Richard Emil Martin, MD
• Susan M Martodam, LRD
• Jenna B Mazour, APRN,CNP
• Rachael McArthur
• Diane Jean McCormack, MS, OTR/L
• Tina McDonald
• Michael Joseph McGregor, PA-C

• Optometrist in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.