MEDICARE: DR. JUDSON FORD AVILA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5698	OH
2	152W00000X	Optometrist	18003539A	IN

General Provider Information

NPI Number	:	1205035037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDSON FORD AVILA O.D.

Provider Business Mailing Address
First Line	:	9795 CROSSPOINT BLVD
Second Line	:	STE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3354
Country	:	US
Telephone Number	:	317-254-6480
Fax Number	:	317-259-8609

Provider Business Practice Location Address
First Line	:	2902 W 86TH ST STE 160
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-2196
Country	:	US
Telephone Number	:	317-254-6480
Fax Number	:	317-259-8609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	09/09/2014

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Directions to “ DR. JUDSON FORD AVILA O.D.” Practice Location

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