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General NPI Number Information
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NPI Number | 1790802130
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Entity Type | Organization
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Legal Business Name | HARRY J. LANDRUM, JR, OD, PC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 10 BAKER BLVD
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City | MULLICA HILL
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State | NJ
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Zip | 08062-1504
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Country | US
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Telephone | 856-223-9100
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Fax | 856-223-1626
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Provider Business Mailing Address
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Address Line | 10 BAKER BLVD
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City | MULLICA HILL
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State | NJ
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Zip | 08062-1504
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Country | US
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Telephone | 856-223-9100
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Fax | 856-223-1626
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HARRY J. LANDRUM JR.
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Credential | O.D.
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Telephone | 856-223-9100
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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 | ML0431572
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License Number State | NJ
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