Provider Demographics
NPI:1346345006
Name:CUDWORTH, BETH ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:CUDWORTH
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 1:2276 WEBSTER PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-7457
Mailing Address - Country:US
Mailing Address - Phone:517-545-3138
Mailing Address - Fax:
Practice Address - Street 1:3850 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8593
Practice Address - Country:US
Practice Address - Phone:517-548-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003285152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist