Provider Demographics
NPI:1760644215
Name:MICHAEL L LANDAU OD PA
Entity Type:Organization
Organization Name:MICHAEL L LANDAU OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANDAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-361-7455
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:33149-1536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
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:33149-1536
Practice Address - Country:US
Practice Address - Phone:305-361-7455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0917460001Medicare NSC