Provider Demographics
NPI:1538249834
Name:LANDRUM, STEVEN WAYNE SR (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
Last Name:LANDRUM
Suffix:SR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:314 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560
Mailing Address - Country:US
Mailing Address - Phone:337-367-3834
Mailing Address - Fax:337-367-3837
Practice Address - Street 1:314 CHARLES ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3772
Practice Address - Country:US
Practice Address - Phone:337-367-3834
Practice Address - Fax:337-367-3837
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA866181T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1334430Medicaid
LA720895251OtherINSURANCE
LA49415Medicare ID - Type UnspecifiedMEDICARE