Provider Demographics
NPI:1093387144
Name:LETO, ANDREW MARK (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARK
Last Name:LETO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 CONNELL PARK LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6539
Mailing Address - Country:US
Mailing Address - Phone:225-490-5363
Mailing Address - Fax:
Practice Address - Street 1:550 CONNELL PARK LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6539
Practice Address - Country:US
Practice Address - Phone:225-490-5363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1938-874AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist