Healthcare Provider Details

I. General information

NPI: 1760644215
Provider Name (Legal Business Name): MICHAEL L LANDAU OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 CRANDON BLVD SUITE 44
KEY BISCAYNE FL
33149-1536
US

IV. Provider business mailing address

260 CRANDON BLVD SUITE 44
KEY BISCAYNE FL
33149-1536
US

V. Phone/Fax

Practice location:
  • Phone: 305-361-7455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL L LANDAU
Title or Position: OPTOMETRIST
Credential:
Phone: 305-361-7455