Provider Demographics
NPI:1144237116
Name:DUDA, JODI LYNNE (OD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:LYNNE
Last Name:DUDA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LYNNE
Other - Last Name:RICHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:547 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-1479
Mailing Address - Country:US
Mailing Address - Phone:570-297-2970
Mailing Address - Fax:570-297-5057
Practice Address - Street 1:547 CANTON ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-1479
Practice Address - Country:US
Practice Address - Phone:570-297-2970
Practice Address - Fax:570-297-5057
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013916500007Medicaid
PA0013916500007Medicaid
U33406Medicare UPIN