Healthcare Provider Details

I. General information

NPI: 1407717671
Provider Name (Legal Business Name): NINA IVANOVNA KUDIMOVA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 N PLUM ST
SPRINGFIELD OH
45504-2108
US

IV. Provider business mailing address

6945 BLUEBIRD PL
HILLIARD OH
43026-2276
US

V. Phone/Fax

Practice location:
  • Phone: 937-629-4085
  • Fax:
Mailing address:
  • Phone: 608-799-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007478
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: