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General NPI Number Information
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NPI Number | 1154541654
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Entity Type | Organization
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Legal Business Name | SCOTT LANDES OD, PA
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 1710 S HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67211-4021
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Country | US
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Telephone | 316-684-2362
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 S HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67211-4021
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | SCOTT LANDES
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Credential |
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Telephone | 316-684-2362
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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 | 1086-2
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License Number State | KS
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