=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710199260
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LORI M. LANDRIO OD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2007
-----------------------------------------------------
Last Update Date | 04/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2126 MERRICK MALL
-----------------------------------------------------
City | MERRICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11566-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-546-4800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 WHITE BIRCH DR
-----------------------------------------------------
City | DIX HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11746-7719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-423-0416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LORI LANDRIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-423-0416
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 5873
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------