Provider Demographics
NPI:1154940930
Name:LANDIS, BECCA TRIEU (MD)
Entity type:Individual
Prefix:
First Name:BECCA
Middle Name:TRIEU
Last Name:LANDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HAI
Other - Middle Name:
Other - Last Name:TRIEU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST # BA-2720
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-1160
Practice Address - Fax:706-721-1158
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA11859207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program