MEDICARE: MARIA ADRIANA LANDIN

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	156FX1800X	Optician
2	332H00000X	Eyewear Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932621430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ADRIANA LANDIN

Provider Business Mailing Address
First Line	:	2406 GUS THOMASSON RD STE A
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-3007
Country	:	US
Telephone Number	:	469-399-7140
Fax Number	:	844-273-1069

Provider Business Practice Location Address
First Line	:	2406 GUS THOMASSON RD STE A
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-3007
Country	:	US
Telephone Number	:	469-399-7140
Fax Number	:	844-273-1069

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

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	07/21/2022

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Directions to “ MARIA ADRIANA LANDIN ” Practice Location

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