MEDICARE: DR. EZRA G UDOFF 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	OP100060	DC
2	152W00000X	Optometrist	0618	VA

General Provider Information

NPI Number	:	1336283522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EZRA G UDOFF O.D.

Provider Business Mailing Address
First Line	:	635 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-4303
Country	:	US
Telephone Number	:	202-546-2838
Fax Number	:	202-543-3033

Provider Business Practice Location Address
First Line	:	635 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-4303
Country	:	US
Telephone Number	:	202-546-2838
Fax Number	:	202-543-3033

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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