1427521665 NPI number — LANDA VISION, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427521665 NPI number — LANDA VISION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANDA VISION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427521665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10983 VINEYARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH EAST
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16428-6619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-602-3295
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5158 PEACH ST UNIT 20B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16509-2489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-520-5743
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LANDA
Authorized Official First Name:
JESSIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
724-602-3295

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)