Provider Demographics
NPI:1548321458
Name:LAKHER, MICHAEL (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LAKHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:MIKHAIL
Other - Middle Name:
Other - Last Name:LAKHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:781-431-7762
Mailing Address - Fax:617-232-9201
Practice Address - Street 1:318 HARVARD ST S 10
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-232-9200
Practice Address - Fax:617-232-9201
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B20929001OtherCIGNA
5856168OtherAETNA
MALAW15749OtherBLUE CROSS
762361OtherTUFTS HEALTH PLAN
U30748OtherHARVARD PILGRIM
MA3437OtherEYE MED COLE
2200040OtherUNITED HEALTH CARE
MA0354414Medicaid
12119OtherSPECTERA
455158Medicare ID - Type Unspecified
762361OtherTUFTS HEALTH PLAN