Provider Demographics
NPI:1932271095
Name:CACIOPPO, LEONARD R (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:R
Last Name:CACIOPPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14543 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6065
Mailing Address - Country:US
Mailing Address - Phone:352-596-4030
Mailing Address - Fax:352-596-1997
Practice Address - Street 1:14543 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6065
Practice Address - Country:US
Practice Address - Phone:352-596-4030
Practice Address - Fax:352-596-1997
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME035752207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00008818OtherADVANTICA
FL038281700Medicaid
FL79548ZMedicare ID - Type Unspecified
FL038281700Medicaid