MEDICARE: LEONI 2MED LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	439415399A	OTHER	LA	BLUE CROSS OF LA

General Provider Information

NPI Number	:	1184812414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEONI 2MED LLC

Provider Business Mailing Address
First Line	:	203 RUE LOUIS XIV
Second Line	:	SUITE A
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5736
Country	:	US
Telephone Number	:	337-981-2393
Fax Number	:	337-981-9470

Provider Business Practice Location Address
First Line	:	203 RUE LOUIS XIV
Second Line	:	SUITE A
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5736
Country	:	US
Telephone Number	:	337-981-2393
Fax Number	:	337-981-9470

Authorized Official
Title or Position	:	OWNER
Name	:	RICARDO LEONI II
Credential	:	MD
Telephone Number	:	337-981-2393

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	01/24/2020

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Directions to “LEONI 2MED LLC ” Practice Location

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