Healthcare Provider Details

I. General information

NPI: 1457540205
Provider Name (Legal Business Name): JEFFREY R. LANDER, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 LEADERS HEIGHTS RD
YORK PA
17402-5024
US

IV. Provider business mailing address

309 LEADERS HEIGHTS RD
YORK PA
17402-5024
US

V. Phone/Fax

Practice location:
  • Phone: 717-747-5430
  • Fax: 717-747-5230
Mailing address:
  • Phone: 717-747-5430
  • Fax: 717-747-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000209
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD026838E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number6000006434
License Number StatePA

VIII. Authorized Official

Name: DR. JEFFREY RICHARD LANDER
Title or Position: OWNER
Credential: M.D.
Phone: 717-747-5430