Individual provider Active NPI

Maria Joy Mandese, O.D.

  • Optometrist
  • Orlando, FL
National Provider Identifier
1275609794
Registry record updated Sep 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC 4406 Issued in FL
Practice address
5201 Raymond St
Orlando, FL 32803-8208
Phone
(407) 629-1599
Fax
(407) 599-1340
NPI assigned
Nov 27, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TUV007099 NY
Optometrist 152W00000X OPC 4406 FL Primary
Optometrist 152W00000X OFC32 FL

Addresses

Primary practice location

5201 Raymond St
Orlando, FL 32803-8208

Mailing address

5201 Raymond St
Orlando, FL 32803-8208
Phone (407) 629-1599

Other identifiers 1

IdentifierTypeStateIssuer
621285900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240926001916 FL Order and Referring Only - OptometryPractitioner - Optometry 2769569920

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC 4406FLMDOptometrist
TUV007099NYMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316995200000",
    "number": "1275609794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 RAYMOND ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328038208",
            "telephone_number": "407-629-1599",
            "fax_number": "407-599-1340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 RAYMOND ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328038208",
            "telephone_number": "407-629-1599",
            "fax_number": "407-599-1340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDESE",
        "first_name": "MARIA",
        "middle_name": "JOY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2011-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007099",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 4406",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OFC32",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621285900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.