Healthcare Provider Details

I. General information

NPI: 1528945581
Provider Name (Legal Business Name): CHASE N LUDFORD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 4TH ST
PERU IL
61354-3309
US

IV. Provider business mailing address

1921 4TH ST
PERU IL
61354-3309
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-0151
  • Fax: 815-223-0307
Mailing address:
  • Phone: 815-223-0151
  • Fax: 815-223-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.012028
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: