Provider Demographics
NPI:1689647232
Name:LANDRY, PATTI A (OD)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:A
Last Name:LANDRY
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:PO BOX 425789
Mailing Address - Street 2:MEDICAL E23-395
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-0015
Mailing Address - Country:US
Mailing Address - Phone:617-253-4351
Mailing Address - Fax:
Practice Address - Street 1:77 MASS AVE
Practice Address - Street 2:MEDICAL E23-395
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4301
Practice Address - Country:US
Practice Address - Phone:617-253-4351
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW15805OtherBLUE CROSS
MA451358Medicare ID - Type Unspecified
MAW15805OtherBLUE CROSS