Healthcare Provider Details

I. General information

NPI: 1306480934
Provider Name (Legal Business Name): DR CHARLES HUDAK & ASSOC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MARKETPLACE ML STE 125
PLAINFIELD IN
46168-5542
US

IV. Provider business mailing address

4020 LAFAYETTE RD
INDIANAPOLIS IN
46254-2506
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-6002
  • Fax:
Mailing address:
  • Phone: 317-293-9314
  • Fax: 317-295-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CHARLES MICHAEL HUDAK
Title or Position: CEO
Credential: O.D.
Phone: 317-554-7851