MEDICARE: CHERYL K HUDISH 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	OET008805	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639166507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL K HUDISH O.D.

Provider Business Mailing Address
First Line	:	1465 LANCASTER RD
Second Line	:
City	:	MANHEIM
State	:	PA
Zip	:	17545-9768
Country	:	US
Telephone Number	:	717-879-6900
Fax Number	:	717-879-6901

Provider Business Practice Location Address
First Line	:	1465 LANCASTER RD
Second Line	:
City	:	MANHEIM
State	:	PA
Zip	:	17545-9768
Country	:	US
Telephone Number	:	717-879-6900
Fax Number	:	717-879-6901

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	01/08/2021

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