Provider Demographics
NPI:1053412114
Name:KLEAMENAKIS, MICHAEL NICHOLAS (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NICHOLAS
Last Name:KLEAMENAKIS
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 1:4114 MARIGNY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4931
Mailing Address - Country:US
Mailing Address - Phone:504-288-2333
Mailing Address - Fax:504-288-2227
Practice Address - Street 1:4114 MARIGNY ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-4931
Practice Address - Country:US
Practice Address - Phone:504-288-2333
Practice Address - Fax:504-288-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA0130-060T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1370142Medicaid
T19548Medicare UPIN
48365Medicare ID - Type Unspecified