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NPI Code Detail

MEDICARE: LESLIE R ALONZO III O.D.

MEDICARE: LESLIE R ALONZO III O.D.
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
1152W00000XOptometristOPC2323FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14388598OTHERFLAETNA
26500152OTHERFLGHI
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
42074336OTHERFLAETNA
519254OTHERFLBCBS FLORIDA
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598762395
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE R ALONZO III O.D.
Provider Business Mailing Address
First Line : 403 VONDERBURG DR
Second Line :
City : BRANDON
State : FL
Zip : 33511-5982
Country : US
Telephone Number : 813-681-1122
Fax Number : 813-684-4924
Provider Business Practice Location Address
First Line : 403 VONDERBURG DR
Second Line : STE 101
City : BRANDON
State : FL
Zip : 33511-5982
Country : US
Telephone Number : 813-681-1122
Fax Number : 813-684-4924
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 09/11/2020

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Directions to “ LESLIE R ALONZO III O.D.” Practice Location

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