Provider Demographics
NPI:1699176883
Name:CALEB LANDRUM, LLC
Entity Type:Organization
Organization Name:CALEB LANDRUM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CALEB
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-684-5650
Mailing Address - Street 1:530 HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-1916
Mailing Address - Country:US
Mailing Address - Phone:770-684-5650
Mailing Address - Fax:770-684-1539
Practice Address - Street 1:530 HUNTER ST
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-1916
Practice Address - Country:US
Practice Address - Phone:770-684-5650
Practice Address - Fax:770-684-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty