Basic Information
| Provider Information | |||||||||
| NPI: | 1477997591 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANDO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 845347 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752845347 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 THOMAS MORE PKWY | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593414525 | ||||||||
| FaxNumber: | 8593414993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2013 | ||||||||
| LastUpdateDate: | 07/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | TP588 | KY | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | R3264 | KY | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | R2663 | TX | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 51523 | KY | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 35.133827 | OH | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | H588290 | 01 | OH | MEDICARE | OTHER | K242732 | 01 | KY | MEDICARE KY | OTHER | 0283968 | 05 | OH | MEDICAID | H588291 | 01 | OH | MEDICARE OH | OTHER | H588292 | 01 | OH | MEDICARE OH | OTHER | K242730 | 01 | KY | MEDICARE | OTHER | K242731 | 01 | KY | MEDICARE | OTHER | 7100371840 | 05 | KY | MEDICAID |