=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811098577
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN HUDSON OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 7TH ST NW
-----------------------------------------------------
City | CASS LAKE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56633-3360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-335-3200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 7TH ST NW
-----------------------------------------------------
City | CASS LAKE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56633-3360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-335-3200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1719
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 8501
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------