Provider Demographics
NPI:1205035037
Name:AVILA, JUDSON FORD (OD)
Entity Type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:FORD
Last Name:AVILA
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:2902 W 86TH ST STE 160
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2196
Practice Address - Country:US
Practice Address - Phone:317-254-6480
Practice Address - Fax:317-259-8609
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5698152W00000X
IN18003539A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN894060HHMedicare PIN