MEDICARE: EDGAR FERNANDO JUDD OD

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	13396875-9934	UT

General Provider Information

NPI Number	:	1386335503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGAR FERNANDO JUDD OD

Provider Business Mailing Address
First Line	:	598 S 2475 W
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-1969
Country	:	US
Telephone Number	:	435-393-5190
Fax Number	:

Provider Business Practice Location Address
First Line	:	1251 NORTHFIELD RD STE 215
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-8623
Country	:	US
Telephone Number	:	435-865-9899
Fax Number	:

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

Provider Enumeration Date	:	05/18/2023
Last Update Date	:	05/18/2023

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