Provider Demographics
NPI:1700987468
Name:LANDES, SCOTT T (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:T
Last Name:LANDES
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 1:1710 S HILLSIDE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211
Mailing Address - Country:US
Mailing Address - Phone:316-684-2362
Mailing Address - Fax:316-684-2603
Practice Address - Street 1:1710 S HILLSIDE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211
Practice Address - Country:US
Practice Address - Phone:316-684-2362
Practice Address - Fax:316-684-2603
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS10862152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS017012Medicare PIN