Provider Demographics
NPI:1346748225
Name:JUDSON FAMILY VISION CARE, LLC
Entity Type:Organization
Organization Name:JUDSON FAMILY VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:JUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-232-1000
Mailing Address - Street 1:643 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-3525
Mailing Address - Country:US
Mailing Address - Phone:812-232-1000
Mailing Address - Fax:812-232-1007
Practice Address - Street 1:643 OHIO ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3525
Practice Address - Country:US
Practice Address - Phone:812-232-1000
Practice Address - Fax:812-232-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty