Healthcare Provider Details

I. General information

NPI: 1538104963
Provider Name (Legal Business Name): LANDMARK LEASING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BULTMAN DRIVE
SUMTER SC
29150
US

IV. Provider business mailing address

PO BOX 5721
COLUMBIA SC
29150
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-4723
  • Fax: 803-775-5211
Mailing address:
  • Phone: 803-799-8168
  • Fax: 803-799-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MS. EMILY FOLLINE MIKELL
Title or Position: ITS VICE PRESIDENT
Credential:
Phone: 803-799-8168