Provider Demographics
NPI:1730797580
Name:LANDRY, PAUL TAYLOR (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:TAYLOR
Last Name:LANDRY
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 1:483 COLUMBUS AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4631
Mailing Address - Country:US
Mailing Address - Phone:713-320-9493
Mailing Address - Fax:
Practice Address - Street 1:207 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4013
Practice Address - Country:US
Practice Address - Phone:646-335-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9913TG152W00000X
NY009301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty