Provider Demographics
NPI:1477849040
Name:DR LEO EDELSBERG AND ASSOCIATES
Entity Type:Organization
Organization Name:DR LEO EDELSBERG AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-932-7373
Mailing Address - Street 1:19575 BISCAYNE BLVD
Mailing Address - Street 2:# 579
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2325
Mailing Address - Country:US
Mailing Address - Phone:305-932-7373
Mailing Address - Fax:
Practice Address - Street 1:19575 BISCAYNE BLVD
Practice Address - Street 2:# 579
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2325
Practice Address - Country:US
Practice Address - Phone:305-932-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty