MEDICARE: DR. KEN PHILIP LANDESMAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	00414P	NY

General Provider Information

NPI Number	:	1013950310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEN PHILIP LANDESMAN OD

Provider Business Mailing Address
First Line	:	103 S BEDFORD RD
Second Line	:	SUITE 101
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-3440
Country	:	US
Telephone Number	:	914-241-2020
Fax Number	:	914-241-0034

Provider Business Practice Location Address
First Line	:	103 S BEDFORD RD
Second Line	:	SUITE 101
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-3440
Country	:	US
Telephone Number	:	914-241-2020
Fax Number	:	914-241-0034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	01/07/2014

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