Active NPI
Leonard Raymond Maiolatesi Jr.
- Optometrist
- Gulfport, MS
National Provider Identifier
1942406269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 711
- Practice address
- 9350 Highway 49
Gulfport, MS 39503-4213 - Phone
- (228) 863-1859
- NPI assigned
- Jun 23, 2007
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 711 | MS | Primary |
Addresses
Primary practice location
9350 Highway 49
Gulfport, MS 39503-4213
Mailing address
1200 Magnolia Bayou Blvd
Ocean Springs, MS 39564-1203
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 711 | MS | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Binghamton Ophthalmology Associates, P.C. | 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 and National Provider Directory roles.
-
- Eyewear Supplier
- Binghamton, NY
- NPI 1245352996
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942406269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 MAGNOLIA BAYOU BLVD",
"city": "OCEAN SPRINGS",
"state": "MS",
"postal_code": "395641203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9350 HIGHWAY 49",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395034213",
"telephone_number": "228-863-1859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAIOLATESI",
"first_name": "LEONARD",
"middle_name": "RAYMOND",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MS",
"license": "711",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.