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Organization
LEANN J MANDESE OD PA
Active
Organization
LEANN J MANDESE OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEANN J MANDESE (OWNER)
(321) 777-1670
Entity
Organization
Contact information
Practice address
2194 HIGHWAY A1A, SUITE 109, INDIAN HARBOUR BEACH, FL 32937-4930
(321) 777-1640
(321) 773-0187
Mailing address
2194 HIGHWAY A1A, SUITE 109, INDIAN HARBOUR BEACH, FL 32937-4930
(321) 777-1640
(321) 773-0187
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OP3125
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20960
BCBS
FL
01
—
3214353
AETNA PPO
FL
01
—
590467269
TRICARE
FL
01
—
7844091
AETNA
FL
01
—
TID
PRUDENTIAL
FL
Enumeration date
05/07/2007
Last updated
06/18/2021
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