MEDICARE: DR. MICHAEL MERLIN JUDKINS 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	375535-9934	UT

General Provider Information

NPI Number	:	1699774026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL MERLIN JUDKINS O.D.

Provider Business Mailing Address
First Line	:	5331 ADAMS AVE PKWY
Second Line	:	SUITE B
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84405-4753
Country	:	US
Telephone Number	:	801-479-7850
Fax Number	:

Provider Business Practice Location Address
First Line	:	5331 ADAMS AVE PKWY
Second Line	:	SUITE B
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84405-4753
Country	:	US
Telephone Number	:	801-479-7850
Fax Number	:

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	05/18/2012

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