Provider Demographics
NPI:1427254978
Name:LANDSAW O D P A
Entity type:Organization
Organization Name:LANDSAW O D P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANNAH
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:LANDSAW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-853-3153
Mailing Address - Street 1:91284 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2555
Mailing Address - Country:US
Mailing Address - Phone:305-853-3153
Mailing Address - Fax:305-853-3152
Practice Address - Street 1:91284 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2555
Practice Address - Country:US
Practice Address - Phone:305-853-3153
Practice Address - Fax:305-853-3152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620730800Medicaid
FL4449800001Medicare NSC
FL620730800Medicaid