Provider Demographics
NPI:1467644229
Name:GALDAMEZ, JUAN EVENOR (OD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:EVENOR
Last Name:GALDAMEZ
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 1:2901 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2125
Mailing Address - Country:US
Mailing Address - Phone:903-831-5706
Mailing Address - Fax:903-832-4506
Practice Address - Street 1:2901 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2125
Practice Address - Country:US
Practice Address - Phone:903-831-5706
Practice Address - Fax:903-832-4506
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2613152W00000X
MT805152W00000X
TX8094T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1306194519OtherNPPES
MT1467644229OtherNPPES