MEDICARE: DR. JEROME SUDE 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	3046/T812	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410022025	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1418274	OTHER	OH	UNITED HEALTHCARE
3	0655759	OTHER	OH	AETNA HMO
4	341572960B	OTHER	OH	SUMMA
5	728946	OTHER	OH	BUCKEYE
6	000000134329	OTHER	OH	ANTHEM
7	4338408	OTHER	OH	AETNA PPO
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982607727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME SUDE O.D.

Provider Business Mailing Address
First Line	:	PO BOX 207170
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-2117
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	3510 MANCHESTER RD
Second Line	:
City	:	COVENTRY TOWNSHIP
State	:	OH
Zip	:	44319-1415
Country	:	US
Telephone Number	:	330-753-2100
Fax Number	:	330-633-7165

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/08/2021

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Directions to “ DR. JEROME SUDE O.D.” Practice Location

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