Provider Demographics
NPI:1518370840
Name:LEDDA, DIEGO (OD)
Entity Type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:
Last Name:LEDDA
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 1:928 NE 193RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3988
Mailing Address - Country:US
Mailing Address - Phone:617-676-5487
Mailing Address - Fax:
Practice Address - Street 1:8060 NW 155TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5883
Practice Address - Country:US
Practice Address - Phone:305-364-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5034152W00000X
NY008126152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist