Leann J Mandese OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

OP3125 Issued in FL

Legal business name

LEANN J MANDESE OD PA

Practice address

2194 Highway A1A
Suite 109
Indian Harbour Beach, FL 32937-4930

Phone

(321) 777-1640

Fax

(321) 773-0187

NPI assigned

May 7, 2007

Last updated

Jun 18, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Leann J MandeseNPI 1740271642

Title

Owner

Phone

(321) 777-1670

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Leann J. Mandese, O.D.

  • Optometrist
  • Indian Harbour Beach, FL
  • NPI 1740271642
  Medicare reassignment NPD Authorized official
• Jush Patel, OD

  • Optometrist
  • Oregon, OH
  • NPI 1235707597

  FL

  Medicare reassignment NPD
• Edward V Laibl, OD

  • Optometrist
  • Indian Harbour Beach, FL
  • NPI 1245211093
  NPD (past)

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623974400000",
    "number": "1548473887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2194 HIGHWAY A1A",
            "address_2": "SUITE 109",
            "city": "INDIAN HARBOUR BEACH",
            "state": "FL",
            "postal_code": "329374930",
            "telephone_number": "321-777-1640",
            "fax_number": "321-773-0187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2194 HIGHWAY A1A",
            "address_2": "SUITE 109",
            "city": "INDIAN HARBOUR BEACH",
            "state": "FL",
            "postal_code": "329374930",
            "telephone_number": "321-777-1640",
            "fax_number": "321-773-0187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEANN J MANDESE OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A",
        "authorized_official_last_name": "MANDESE",
        "authorized_official_first_name": "LEANN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-777-1670"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OP3125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "3214353",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "590467269",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRUDENTIAL",
            "identifier": "TID",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "20960",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7844091",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica Kostro, DDS
• Jayna Lacko
• Edward V Laibl, OD
• Timothy Corrigan Lang, DDS, MD, PHD
• Laylah Lara, PTA
• Mary Lebeau
• Julia Ann Lee
• Edgardo A Leiva Cardona, DDS
• Lisa L Cummings, DPM, P.a.
• Live Well Counseling, LLC

• Optometrist in Indian Harbour Beach, FL
• Providers in Indian Harbour Beach, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.