MEDICARE: RICHARD A LANDERS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9402	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2547	OTHER		OD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912990193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD A LANDERS OD

Provider Business Mailing Address
First Line	:	3003 FLINTRIDGE DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7949
Country	:	US
Telephone Number	:	678-468-6484
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 SOUTH FREEWAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-2099
Country	:	US
Telephone Number	:	678-468-6484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	03/07/2023

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