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General NPI Number Information
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NPI Number | 1417939604
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Entity Type | Individual
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Provider Name | JONATHAN P LUDLOW OD
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Gender | Male
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 10730A ENDURING FREEDOM DR STE A
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City | FORT DRUM
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State | NY
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Zip | 13602-5405
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Country | US
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Telephone | 315-405-8671
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Fax | 315-773-1820
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Provider Business Mailing Address
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Address Line | 10730A ENDURING FREEDOM DR
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City | FORT DRUM
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State | NY
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Zip | 13602-5405
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Country | US
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Telephone | 315-405-8671
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Fax | 315-971-4633
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV0061121
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License Number State | NY
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