Provider Demographics
NPI:1093359689
Name:DR CHARLES HUDAK & ASSOC LLC
Entity Type:Organization
Organization Name:DR CHARLES HUDAK & ASSOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-554-7851
Mailing Address - Street 1:4020 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2506
Mailing Address - Country:US
Mailing Address - Phone:317-293-9314
Mailing Address - Fax:317-295-0223
Practice Address - Street 1:4020 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2506
Practice Address - Country:US
Practice Address - Phone:317-293-9314
Practice Address - Fax:317-295-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty