Active NPI
Mark Vincent Mandese, LDO
- Optician
- Orlando, FL
National Provider Identifier
1255838462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 3019
- Practice address
- 1717 S Orange Ave
Orlando, FL 32806-2944 - Phone
- (407) 422-6798
- Fax
- (407) 992-7053
- NPI assigned
- Apr 12, 2018
- Last updated
- Apr 12, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 3019 | FL | Primary |
Addresses
Primary practice location
1717 S Orange Ave
Orlando, FL 32806-2944
Mailing address
540 Goldenmoss Loop
Ocoee, FL 34761-4783
Phone (407) 234-5788
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3019 | FL | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children's Eyewear Center, Inc | Optician | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523491200000",
"number": "1255838462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "540 GOLDENMOSS LOOP",
"city": "OCOEE",
"state": "FL",
"postal_code": "347614783",
"telephone_number": "407-234-5788",
"fax_number": "407-992-7053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 S ORANGE AVE",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328062944",
"telephone_number": "407-422-6798",
"fax_number": "407-992-7053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDESE",
"first_name": "MARK",
"middle_name": "VINCENT",
"credential": "LDO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-12",
"last_updated": "2018-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "FL",
"license": "3019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.