MEDICARE: DR. DONNA JOY MANGATT 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	FL4035	FL

General Provider Information

NPI Number	:	1821168741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA JOY MANGATT O.D.

Provider Business Mailing Address
First Line	:	2 E SUFFOLK AVE
Second Line	:
City	:	CENTRAL ISLIP
State	:	NY
Zip	:	11722-2340
Country	:	US
Telephone Number	:	163-171-5755
Fax Number	:	163-123-4010

Provider Business Practice Location Address
First Line	:	4125 CLEVELAND AVE
Second Line	:	SEARS OPTICAL STE 88
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9046
Country	:	US
Telephone Number	:	239-693-3937
Fax Number	:

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	06/16/2021

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