Provider Demographics
NPI:1144206350
Name:HUDGINS, DONATHAN G (OD)
Entity Type:Individual
Prefix:DR
First Name:DONATHAN
Middle Name:G
Last Name:HUDGINS
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 1:2501 ATRIUM DR STE 150
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6674
Mailing Address - Country:US
Mailing Address - Phone:919-272-2541
Mailing Address - Fax:
Practice Address - Street 1:2501 ATRIUM DR STE 150
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6674
Practice Address - Country:US
Practice Address - Phone:919-272-2541
Practice Address - Fax:919-794-3046
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909400Medicaid
NCD44712Medicare UPIN
NC2468592Medicare PIN