Provider Demographics
NPI:1285856542
Name:HUDSON, ANDREA BEAVERS (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:BEAVERS
Last Name:HUDSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:621 EASTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1923
Mailing Address - Country:US
Mailing Address - Phone:205-447-6774
Mailing Address - Fax:
Practice Address - Street 1:2937 7TH AVE S
Practice Address - Street 2:STE 104
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2927
Practice Address - Country:US
Practice Address - Phone:205-447-6774
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-881-TA-462152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU71876Medicare UPIN