Provider Demographics
NPI:1477997591
Name:MANDO, JOSEPH THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:MANDO
Suffix:
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:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-341-4525
Practice Address - Fax:859-341-4993
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP588207W00000X
KYR3264207W00000X
TXR2663207W00000X
KY51523207W00000X
OH35.133827207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH588290OtherMEDICARE
KYK242732OtherMEDICARE KY
OH0283968Medicaid
OHH588291OtherMEDICARE OH
OHH588292OtherMEDICARE OH
KYK242730OtherMEDICARE
KYK242731OtherMEDICARE
KY7100371840Medicaid