Healthcare Provider Details

I. General information

NPI: 1386227239
Provider Name (Legal Business Name): MALENA LANDON ERICKSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E VETERANS DR
COOKEVILLE TN
38501-4038
US

IV. Provider business mailing address

3466 MANASSAS RD
COOKEVILLE TN
38506-6332
US

V. Phone/Fax

Practice location:
  • Phone: 931-372-1994
  • Fax:
Mailing address:
  • Phone: 615-719-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0003678
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3941
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: