Provider Demographics
NPI:1881656577
Name:LEONARD, ELISE ROBERTA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:ROBERTA
Last Name:LEONARD
Suffix:
Gender:F
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:P.O. BOX 39209
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FT. LAUDERDATE
Mailing Address - State:FL
Mailing Address - Zip Code:33339
Mailing Address - Country:US
Mailing Address - Phone:954-851-9966
Mailing Address - Fax:954-318-7360
Practice Address - Street 1:8890 W. OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351
Practice Address - Country:US
Practice Address - Phone:954-746-7040
Practice Address - Fax:954-572-0906
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039592174400000X
FLME39592207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066862100Medicaid
FL94044ZMedicare PIN
FL066862100Medicaid
FL94044Medicare PIN