Organization
HARRY J. LANDRUM, JR, OD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HARRY J. LANDRUM JR. O.D. (PRESIDENT)
(215) 334-2020
Entity
Organization
Contact information
Practice address
1808 W SHUNK ST, PHILADELPHIA, PA 19145-3708
(215) 334-2020
(215) 334-1419
Mailing address
1808 W SHUNK ST, PHILADELPHIA, PA 19145-3708
(215) 334-2020
(215) 334-1419
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001641
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000401703
HIGHMARK BLUE SHIELD ID
PA
01
—
0097517000
KEYSTONE HMO
PA
Enumeration date
03/22/2007
Last updated
12/08/2011
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