Provider Demographics
NPI:1821168741
Name:MANGATT, DONNA JOY (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:JOY
Last Name:MANGATT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 E SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-2340
Mailing Address - Country:US
Mailing Address - Phone:163-171-5755
Mailing Address - Fax:163-123-4010
Practice Address - Street 1:4125 CLEVELAND AVE
Practice Address - Street 2:SEARS OPTICAL STE 88
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9046
Practice Address - Country:US
Practice Address - Phone:239-693-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL4035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist