Provider Demographics
NPI:1255311460
Name:LEON, MICHAEL J JR
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:LEON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 S BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5356
Mailing Address - Country:US
Mailing Address - Phone:321-725-4755
Mailing Address - Fax:321-725-5088
Practice Address - Street 1:2420 S BABCOCK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5356
Practice Address - Country:US
Practice Address - Phone:321-725-4755
Practice Address - Fax:321-725-5088
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0002189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38200OtherBCBS
FL38200AOtherBCBS
FL38200AOtherBCBS
FL38200OtherBCBS
FL19091UMedicare PIN
FL19091YMedicare PIN
FLT85267Medicare UPIN