Provider Demographics
NPI:1235159708
Name:LEONI, RICARDO R II (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:R
Last Name:LEONI
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 RUE LOUIS XIV
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5736
Mailing Address - Country:US
Mailing Address - Phone:337-981-2393
Mailing Address - Fax:
Practice Address - Street 1:203 RUE LOUIS XIV
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5736
Practice Address - Country:US
Practice Address - Phone:337-981-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022671207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497126Medicare ID - Type Unspecified
LA5E255Medicare ID - Type Unspecified
KYG85889Medicare UPIN