Provider Demographics
NPI:1568512911
Name:LANDSAW, JANNAH MILLER (OD)
Entity Type:Individual
Prefix:DR
First Name:JANNAH
Middle Name:MILLER
Last Name:LANDSAW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91284 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2555
Mailing Address - Country:US
Mailing Address - Phone:305-853-3153
Mailing Address - Fax:305-853-3152
Practice Address - Street 1:91284 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2555
Practice Address - Country:US
Practice Address - Phone:305-853-3153
Practice Address - Fax:305-853-3152
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3357152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4449800001OtherMEDICARE NSC
FL620717100Medicaid
FL4449800001OtherMEDICARE NSC
FLU89707Medicare UPIN
FL410049566Medicare PIN