Leon Francis Favede, O.D.
Individual provider
Active NPI
Optometrist · Bridgeport, OH
NPI 1356435481 · NPPES record last updated Dec 5, 2012
Key facts
- NPI
- 1356435481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2658/T427 (OH)
- Practice address
- 100 3Rd St
Bridgeport, OH 43912-1605
- Phone
- (740) 635-0814
- Fax
- (740) 635-2521
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20101123000438 |
OH |
Practitioner - Optometry |
6800901059 |
Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| 2658/T427 | OH | MD | Optometrist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Optometrist |
152W00000X |
2658/T427 |
OH |
Yes |
Addresses
Primary practice location
100 3Rd St
Bridgeport, OH 43912-1605
Mailing address
100 3Rd St
Bridgeport, OH 43912-1605
Phone (740) 635-0814
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 2672504 | Medicaid | OH | |