Provider Demographics
NPI:1255924742
Name:PERRY, LANDON ROBERT (OD)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:ROBERT
Last Name:PERRY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1517
Mailing Address - Country:US
Mailing Address - Phone:614-262-2020
Mailing Address - Fax:614-262-1948
Practice Address - Street 1:3130 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1517
Practice Address - Country:US
Practice Address - Phone:614-262-2020
Practice Address - Fax:614-262-1948
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist