Provider Demographics
NPI:1942336144
Name:JOHN, LUDIAMMA (OD)
Entity Type:Individual
Prefix:DR
First Name:LUDIAMMA
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 GARTH RD
Mailing Address - Street 2:STE J
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2162
Mailing Address - Country:US
Mailing Address - Phone:832-526-4000
Mailing Address - Fax:
Practice Address - Street 1:4506 GARTH RD
Practice Address - Street 2:STE J
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2162
Practice Address - Country:US
Practice Address - Phone:832-526-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5619TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160331801Medicaid