Provider Demographics
NPI:1376956102
Name:LUDWIG, ERIC D (OD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 JEFFERSON LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1989
Mailing Address - Country:US
Mailing Address - Phone:631-832-7337
Mailing Address - Fax:888-747-6545
Practice Address - Street 1:30 JEFFERSON LANDING CIR
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1989
Practice Address - Country:US
Practice Address - Phone:631-832-7337
Practice Address - Fax:888-747-6545
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008112-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist