Provider Demographics
NPI:1932621430
Name:LANDIN, MARIA ADRIANA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ADRIANA
Last Name:LANDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 GUS THOMASSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-3007
Mailing Address - Country:US
Mailing Address - Phone:469-399-7140
Mailing Address - Fax:844-273-1069
Practice Address - Street 1:2406 GUS THOMASSON RD STE A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-3007
Practice Address - Country:US
Practice Address - Phone:469-399-7140
Practice Address - Fax:844-273-1069
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1295261113Medicaid