Provider Demographics
NPI:1457401051
Name:LANDON, EDWARD C (OD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:LANDON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:19036 SOLEDAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3217
Mailing Address - Country:US
Mailing Address - Phone:661-251-8055
Mailing Address - Fax:661-251-3079
Practice Address - Street 1:16656 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-3217
Practice Address - Country:US
Practice Address - Phone:661-251-8055
Practice Address - Fax:661-251-3079
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT6497 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist