Provider Demographics
NPI:1093907537
Name:LEONARDI GROUP, INC
Entity Type:Organization
Organization Name:LEONARDI GROUP, INC
Other - Org Name:SHAWNEE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:U
Authorized Official - Last Name:LEONARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-838-2020
Mailing Address - Street 1:2203 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4501
Mailing Address - Country:US
Mailing Address - Phone:814-838-2020
Mailing Address - Fax:
Practice Address - Street 1:128 W 12TH ST STE 200
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1752
Practice Address - Country:US
Practice Address - Phone:814-456-9925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018578370001Medicaid
PA5007270010Medicare NSC