Provider Demographics
NPI:1639141237
Name:ZELEZNIK-LANDIS, MIROSLAVA (OD)
Entity Type:Individual
Prefix:DR
First Name:MIROSLAVA
Middle Name:
Last Name:ZELEZNIK-LANDIS
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 1:4130 KELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1028
Mailing Address - Country:US
Mailing Address - Phone:724-325-4099
Mailing Address - Fax:
Practice Address - Street 1:1768C GOLDEN MILE HWY
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2012
Practice Address - Country:US
Practice Address - Phone:724-345-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001101152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012851100003Medicaid
PAU10819Medicare UPIN
PA0012851100003Medicaid