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General NPI Number Information
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NPI Number | 1023077542
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Entity Type | Organization
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Legal Business Name | GISELLE LANDER OD INC
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 07/08/2010
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Provider Practice Location Address
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Address Line | 5035 MAYFIELD RD STE 110
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City | LYNDHURST
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State | OH
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Zip | 44124
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Country | US
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Telephone | 216-291-2020
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Fax | 216-291-2057
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Provider Business Mailing Address
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Address Line | 5035 MAYFIELD RD STE 110
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City | LYNDHURST
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State | OH
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Zip | 44124
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Country | US
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Telephone | 216-291-2020
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Fax | 216-291-2057
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Authorized Official
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Title or Position | OPTOMETRIST OWNER
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Name | GISELLE A LANDER
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Credential | OD
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Telephone | 216-291-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 37171T936
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License Number State | OH
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