Healthcare Provider Details

I. General information

NPI: 1609959436
Provider Name (Legal Business Name): DENISE M. KUDER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35901 CHESTER RD
AVON OH
44011-1069
US

IV. Provider business mailing address

35901 CHESTER RD
AVON OH
44011-1069
US

V. Phone/Fax

Practice location:
  • Phone: 440-937-4765
  • Fax:
Mailing address:
  • Phone: 440-937-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4760/ T1564
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: