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General NPI Number Information
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NPI Number | 1457401051
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Entity Type | Individual
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Provider Name | EDWARD C LANDON O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 16656 SOLEDAD CANYON RD
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City | CANYON COUNTRY
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State | CA
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Zip | 91387-3217
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Country | US
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Telephone | 661-251-8055
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Fax | 661-251-3079
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Provider Business Mailing Address
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Address Line | 19036 SOLEDAD CANYON RD
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City | CANYON COUNTRY
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State | CA
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Zip | 91351-3217
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Country | US
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Telephone | 661-251-8055
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Fax | 661-251-3079
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT6497 TPA
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License Number State | CA
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