Healthcare Provider Details
I. General information
NPI: 1477997591
Provider Name (Legal Business Name): JOSEPH THOMAS MANDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 04/19/2013
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
360 S GARDEN WAY STE 250
EUGENE OR
97401-8175
US
IV. Provider business mailing address
360 S GARDEN WAY STE 250
EUGENE OR
97401-8175
US
V. Phone/Fax
- Phone: 541-343-5000
- Fax:
- Phone: 541-343-5000
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207W00000X |
| Taxonomy | Ophthalmology Physician |
| License Number | 51523 |
| License Number State | KY |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207W00000X |
| Taxonomy | Ophthalmology Physician |
| License Number | R3264 |
| License Number State | KY |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207W00000X |
| Taxonomy | Ophthalmology Physician |
| License Number | 35.133827 |
| License Number State | OH |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207W00000X |
| Taxonomy | Ophthalmology Physician |
| License Number | R2663 |
| License Number State | TX |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207W00000X |
| Taxonomy | Ophthalmology Physician |
| License Number | TP588 |
| License Number State | KY |
| # 6 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207W00000X |
| Taxonomy | Ophthalmology Physician |
| License Number | MD212048 |
| License Number State | OR |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 0283968 |
| Identifier Type | MEDICAID |
| Identifier State | OH |
| Identifier Issuer | |
| # 2 | |
| Identifier | 7100371840 |
| Identifier Type | MEDICAID |
| Identifier State | KY |
| Identifier Issuer | |
| # 3 | |
| Identifier | K242731 |
| Identifier Type | OTHER |
| Identifier State | KY |
| Identifier Issuer | MEDICARE |
| # 4 | |
| Identifier | H588291 |
| Identifier Type | OTHER |
| Identifier State | OH |
| Identifier Issuer | MEDICARE OH |
| # 5 | |
| Identifier | H588290 |
| Identifier Type | OTHER |
| Identifier State | OH |
| Identifier Issuer | MEDICARE |
| # 6 | |
| Identifier | K242730 |
| Identifier Type | OTHER |
| Identifier State | KY |
| Identifier Issuer | MEDICARE |
| # 7 | |
| Identifier | H588292 |
| Identifier Type | OTHER |
| Identifier State | OH |
| Identifier Issuer | MEDICARE OH |
| # 8 | |
| Identifier | K242732 |
| Identifier Type | OTHER |
| Identifier State | KY |
| Identifier Issuer | MEDICARE KY |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
