Provider Demographics
NPI:1679980445
Name:LANDRUM, JOHN CALEB
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CALEB
Last Name:LANDRUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-1916
Mailing Address - Country:US
Mailing Address - Phone:770-684-5650
Mailing Address - Fax:770-684-1539
Practice Address - Street 1:530 HUNTER ST
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-1916
Practice Address - Country:US
Practice Address - Phone:770-684-5650
Practice Address - Fax:770-684-1539
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002831152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist