Provider Demographics
NPI:1063601912
Name:LANDA, JESSIE JO (OD)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:JO
Last Name:LANDA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:JO
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:853 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3870
Mailing Address - Country:US
Mailing Address - Phone:724-225-6050
Mailing Address - Fax:724-225-0890
Practice Address - Street 1:853 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3870
Practice Address - Country:US
Practice Address - Phone:724-225-6050
Practice Address - Fax:724-225-0890
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist