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General NPI Number Information
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NPI Number | 1669521027
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Entity Type | Organization
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Legal Business Name | JUDISCH VISION PC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 1341 W MAIN ST
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City | LAKE CITY
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State | IA
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Zip | 51449-0124
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Country | US
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Telephone | 712-464-3136
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Fax | 712-464-7683
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Provider Business Mailing Address
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Address Line | 1341 W MAIN ST PO BOX 124
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City | LAKE CITY
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State | IA
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Zip | 51449-0124
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Country | US
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Telephone | 712-464-3136
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Fax | 712-464-7683
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN PAUL JUDISCH
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Credential | OD
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Telephone | 712-464-3136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1862
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 02262
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License Number State | IA
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