Provider Demographics
NPI:1376646802
Name:LANDAU, MICHAEL LAWRENCE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:LANDAU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:260 CRANDON BLVD
Mailing Address - Street 2:SUITE 44
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149
Mailing Address - Country:US
Mailing Address - Phone:305-361-7455
Mailing Address - Fax:305-361-8973
Practice Address - Street 1:260 CRANDON BLVD
Practice Address - Street 2:SUITE 44
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149
Practice Address - Country:US
Practice Address - Phone:305-361-7455
Practice Address - Fax:305-361-8973
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U45146Medicare UPIN
FL19673Medicare PIN