Provider Demographics
NPI:1184812414
Name:LEONI 2MED LLC
Entity type:Organization
Organization Name:LEONI 2MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONI
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:337-981-2393
Mailing Address - Street 1:203 RUE LOUIS XIV
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5736
Mailing Address - Country:US
Mailing Address - Phone:337-981-2393
Mailing Address - Fax:337-981-9470
Practice Address - Street 1:203 RUE LOUIS XIV
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5736
Practice Address - Country:US
Practice Address - Phone:337-981-2393
Practice Address - Fax:337-981-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X, 207WX0009X
LAMD.022671207W00000X
LAMD.204569207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2311913Medicaid
LA439415399AOtherBLUE CROSS OF LA
LA2311913Medicaid