Provider Demographics
NPI:1831538552
Name:LANDES, MARC TODD (OD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:TODD
Last Name:LANDES
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 1:2234 CROSS CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1273
Mailing Address - Country:US
Mailing Address - Phone:330-606-2880
Mailing Address - Fax:
Practice Address - Street 1:905 SINGLETARY DR
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-3975
Practice Address - Country:US
Practice Address - Phone:330-422-2168
Practice Address - Fax:330-422-2170
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085936Medicaid
OH0129078Medicaid