Provider Demographics
NPI:1245061076
Name:STURDIVANT, LANDON
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:
Last Name:STURDIVANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E PARKER RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5112
Mailing Address - Country:US
Mailing Address - Phone:828-433-1000
Mailing Address - Fax:
Practice Address - Street 1:335 E PARKER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5112
Practice Address - Country:US
Practice Address - Phone:828-433-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2046-992AT152W00000X
NC2832152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist