Provider Demographics
NPI:1225348899
Name:HUDSON, ASHLEY DOMINIQUE (OD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DOMINIQUE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 CROFTON CT
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050
Mailing Address - Country:US
Mailing Address - Phone:617-797-6062
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 22 AND COLONIAL RD.
Practice Address - Street 2:SUITE 74
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109
Practice Address - Country:US
Practice Address - Phone:717-657-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1612152W00000X
PAOEG002400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist