Provider Demographics
NPI:1699737817
Name:INDIANER, LEONARD E (OD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:E
Last Name:INDIANER
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 1:25D COLLEGE AVE W
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-4529
Mailing Address - Country:US
Mailing Address - Phone:813-886-2020
Mailing Address - Fax:813-886-7222
Practice Address - Street 1:25D COLLEGE AVE W
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-4529
Practice Address - Country:US
Practice Address - Phone:813-886-2020
Practice Address - Fax:813-886-7222
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19561AOtherMEDICARE ID
FL084057200Medicaid
FL084057200Medicaid
FL19561Medicare ID - Type Unspecified