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General NPI Number Information
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NPI Number | 1821168741
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Entity Type | Individual
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Provider Name | DONNA JOY MANGATT O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 4125 CLEVELAND AVE SEARS OPTICAL STE 88
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City | FORT MYERS
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State | FL
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Zip | 33901-9046
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Country | US
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Telephone | 239-693-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 2 E SUFFOLK AVE
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City | CENTRAL ISLIP
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State | NY
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Zip | 11722-2340
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Country | US
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Telephone | 163-171-5755
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Fax | 163-123-4010
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | FL4035
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License Number State | FL
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