Individual provider Active NPI

Leon Michael Favede, O.D.

  • Optometrist
  • Bridgeport, OH
National Provider Identifier
1851485015
Registry record updated Mar 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4452/T1108 Issued in OH
Practice address
100 3Rd St
Bridgeport, OH 43912-1605
Phone
(740) 635-0814
Fax
(740) 635-2521
NPI assigned
Oct 3, 2006
Last updated
Mar 12, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4452/T1108 OH Primary

Addresses

Primary practice location

100 3Rd St
Bridgeport, OH 43912-1605

Mailing address

100 3Rd St
Bridgeport, OH 43912-1605
Phone (740) 635-2020

Other identifiers 1

IdentifierTypeStateIssuer
0979615MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101112000927 OH Practitioner - Optometry 9739294125 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

100 3Rd St
Bridgeport, OH 43912-1605
Phone (740) 635-2020

PO Box
28 100 Third Street
Bridgeport, OH 43912-1605

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4452OHMDChiropractor
4452/T1108OHMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Aeg Ohio Professional PC Optometrist CurrentSince Sep 7, 2019 Accepting new patients
Bridgeport Eyecare LLC Optometrist Current Accepting new patients
DRS. Favede & Associates Optometrist CurrentSince Sep 1, 1993 Accepting new patients
Aeg Ohio Professional PC Optometrist CurrentSince Sep 7, 2019 Accepting new patients

Locations

100 3rd St
Bridgeport, OH 43912
Phone (740) 635-0814

33541 Aurora Rd
Solon, OH 44139
Phone (440) 248-2020

Organizations & group practices 4

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773273600000",
    "number": "1851485015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 3RD ST",
            "city": "BRIDGEPORT",
            "state": "OH",
            "postal_code": "439121605",
            "telephone_number": "740-635-2020",
            "fax_number": "740-635-2521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 3RD ST",
            "city": "BRIDGEPORT",
            "state": "OH",
            "postal_code": "439121605",
            "telephone_number": "740-635-0814",
            "fax_number": "740-635-2521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAVEDE",
        "first_name": "LEON",
        "middle_name": "MICHAEL",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "4452/T1108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0979615",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, OH

Sources for this page

Verify at the official NPI Registry.