Provider Demographics
NPI:1003129123
Name:LANDY, DELIA (OD)
Entity type:Individual
Prefix:DR
First Name:DELIA
Middle Name:
Last Name:LANDY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DELIA
Other - Middle Name:
Other - Last Name:GROSHEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:181 COLFAX ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-7762
Mailing Address - Country:US
Mailing Address - Phone:773-620-5993
Mailing Address - Fax:
Practice Address - Street 1:20 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2004
Practice Address - Country:US
Practice Address - Phone:814-368-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-18
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH842152W00000X
NYTUV007766-1152W00000X
PAOEG002555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist