Provider Demographics
NPI:1497730923
Name:HUDSON, MARC A (OD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:HUDSON
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 1:30 CROSSING LANE
Mailing Address - Street 2:STE. 107
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-6354
Mailing Address - Country:US
Mailing Address - Phone:540-463-9350
Mailing Address - Fax:540-463-1722
Practice Address - Street 1:30 CROSSING LANE
Practice Address - Street 2:STE. 107
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-6354
Practice Address - Country:US
Practice Address - Phone:540-463-9350
Practice Address - Fax:540-463-1722
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA152W00000X152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009235728Medicaid
VA106018OtherANTHEM PROVIDER NUMBER
VAU46687Medicare UPIN
VA4459470001Medicare NSC
VA00X223B01Medicare PIN