MEDICARE: LANDON ROBERT PERRY 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	006932	OH

General Provider Information

NPI Number	:	1255924742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANDON ROBERT PERRY OD

Provider Business Mailing Address
First Line	:	3130 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1517
Country	:	US
Telephone Number	:	614-262-2020
Fax Number	:	614-262-1948

Provider Business Practice Location Address
First Line	:	3130 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1517
Country	:	US
Telephone Number	:	614-262-2020
Fax Number	:	614-262-1948

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

Provider Enumeration Date	:	02/16/2021
Last Update Date	:	03/09/2021

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Directions to “ LANDON ROBERT PERRY OD” Practice Location

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