Provider Demographics
NPI:1235115338
Name:LUDFORD, DAVID J (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:LUDFORD
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 1:1921 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-3309
Mailing Address - Country:US
Mailing Address - Phone:815-223-0151
Mailing Address - Fax:815-223-0307
Practice Address - Street 1:1921 4TH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-3309
Practice Address - Country:US
Practice Address - Phone:815-223-0151
Practice Address - Fax:815-223-0307
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0284470001OtherDMERC REGION B
IL05021930OtherBCBS PROVIDER NUMBER
ILL39591OtherPIN NUMBER
IL376400Medicare ID - Type Unspecified
IL05021930OtherBCBS PROVIDER NUMBER