Provider Demographics
NPI:1790802130
Name:HARRY J. LANDRUM, JR, OD, PC
Entity Type:Organization
Organization Name:HARRY J. LANDRUM, JR, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:856-223-9100
Mailing Address - Street 1:10 BAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1504
Mailing Address - Country:US
Mailing Address - Phone:856-223-9100
Mailing Address - Fax:856-223-1626
Practice Address - Street 1:10 BAKER BLVD
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-1504
Practice Address - Country:US
Practice Address - Phone:856-223-9100
Practice Address - Fax:856-223-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJML0431572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000401703OtherHIGHMARK BLUE SHIELD ID
NJ802547OtherAMERIHEALTH
NJ2014109OtherAETNA
PA0097517000OtherKEYSTONE HMO
NJ6091601Medicaid
NJ229660Medicare PIN
PA000401703OtherHIGHMARK BLUE SHIELD ID
NJ802547OtherAMERIHEALTH