Provider Demographics
NPI:1831381300
Name:LANDERS, PATTY C (OPTICIAN)
Entity type:Individual
Prefix:MS
First Name:PATTY
Middle Name:C
Last Name:LANDERS
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 CENTRON DR SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-2500
Mailing Address - Country:US
Mailing Address - Phone:256-350-2020
Mailing Address - Fax:256-350-2548
Practice Address - Street 1:2620 CENTRON DR SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-2500
Practice Address - Country:US
Practice Address - Phone:256-350-2020
Practice Address - Fax:256-350-2548
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier