Provider Demographics
NPI:1871657502
Name:LANDON, GEORGE (OD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:LANDON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051A SIMONSON ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-2163
Mailing Address - Country:US
Mailing Address - Phone:513-367-4262
Mailing Address - Fax:513-367-1643
Practice Address - Street 1:10051A SIMONSON ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-2163
Practice Address - Country:US
Practice Address - Phone:513-367-4262
Practice Address - Fax:513-367-1643
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2914152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU26585Medicare UPIN
OHLA0779033Medicare ID - Type Unspecified