MEDICARE: DR. LEANN J. MANDESE 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
1	152W00000X	Optometrist	OP3125	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1548473887	OTHER	FL	ORGANIZATION

General Provider Information

NPI Number	:	1740271642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEANN J. MANDESE O.D.

Provider Business Mailing Address
First Line	:	2194 HIGHWAY A1A STE 109-110
Second Line	:
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-4930
Country	:	US
Telephone Number	:	321-777-1670
Fax Number	:	321-773-0187

Provider Business Practice Location Address
First Line	:	2194 A1A HWY
Second Line	:	SUITE 109
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-4930
Country	:	US
Telephone Number	:	321-777-1670
Fax Number	:	321-773-0187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	03/15/2021

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Directions to “ DR. LEANN J. MANDESE O.D.” Practice Location

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