Provider Demographics
NPI:1417982240
Name:CUDLIPP, JOHN BRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRIAN
Last Name:CUDLIPP
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 1:98 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1751
Mailing Address - Country:US
Mailing Address - Phone:856-678-2465
Mailing Address - Fax:856-678-7878
Practice Address - Street 1:98 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1751
Practice Address - Country:US
Practice Address - Phone:856-678-2465
Practice Address - Fax:856-678-7878
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5570107Medicaid
NJ5570107Medicaid
NJ0806500001Medicare NSC