Provider Demographics
NPI:1770518177
Name:MENDEZ, LEONARD J (OD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:J
Last Name:MENDEZ
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 1:567 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-4324
Mailing Address - Country:US
Mailing Address - Phone:207-283-4440
Mailing Address - Fax:
Practice Address - Street 1:567 ELM ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-4324
Practice Address - Country:US
Practice Address - Phone:207-283-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT 771 TA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0532073-002MEOtherCIGNA
ME1042298OtherAETNA
ME161400000Medicaid
ME12155OtherANTHEM
ME161400000Medicaid
MEMM4696Medicare PIN
ME0532073-002MEOtherCIGNA