Provider Demographics
NPI:1629158423
Name:LANDRY, DUDLEY JOSEPH JR (OD)
Entity Type:Individual
Prefix:DR
First Name:DUDLEY
Middle Name:JOSEPH
Last Name:LANDRY
Suffix:JR
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 1:623 FANGUE LN
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-5407
Mailing Address - Country:US
Mailing Address - Phone:985-395-9800
Mailing Address - Fax:
Practice Address - Street 1:3005 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4140
Practice Address - Country:US
Practice Address - Phone:337-898-0262
Practice Address - Fax:337-898-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA662-161T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA46141OtherSPECTERA