Provider Demographics
NPI:1255442786
Name:LANDERS, LEONA (OD)
Entity type:Individual
Prefix:DR
First Name:LEONA
Middle Name:
Last Name:LANDERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOWARD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-1629
Mailing Address - Country:US
Mailing Address - Phone:415-908-2733
Mailing Address - Fax:415-908-2738
Practice Address - Street 1:101 HOWARD ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1629
Practice Address - Country:US
Practice Address - Phone:415-908-2733
Practice Address - Fax:415-908-2738
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7829T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0078290Medicaid
CASD0078290Medicaid
CAU23586Medicare UPIN