Provider Demographics
NPI:1063484749
Name:DEXTER, JUDSON K (OD)
Entity Type:Individual
Prefix:MR
First Name:JUDSON
Middle Name:K
Last Name:DEXTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:603-357-2990
Mailing Address - Fax:603-357-4481
Practice Address - Street 1:171 WEST STREET
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-357-2990
Practice Address - Fax:603-357-4481
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0315152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0907873Y0NH02OtherANTHEM
NH150450OtherHEALTHSOURCE
NH30008943Medicaid
NHNH0315OtherEYEMED
NHNH0315OtherVISION SERVICE PLAN
NHU23717Medicare UPIN
NHNH0315OtherEYEMED