Provider Demographics
NPI:1023077542
Name:GISELLE LANDER OD INC
Entity type:Organization
Organization Name:GISELLE LANDER OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:216-291-2020
Mailing Address - Street 1:5035 MAYFIELD RD
Mailing Address - Street 2:STE 110
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:216-291-2020
Mailing Address - Fax:216-291-2057
Practice Address - Street 1:5035 MAYFIELD RD
Practice Address - Street 2:STE 110
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:216-291-2020
Practice Address - Fax:216-291-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH37171T936152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0697287Medicaid
OH9356041Medicare PIN
OH5577370001Medicare NSC