Provider Demographics
NPI:1609842368
Name:RUDNICK, GENE M
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:M
Last Name:RUDNICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21583
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-0583
Mailing Address - Country:US
Mailing Address - Phone:423-892-2422
Mailing Address - Fax:423-892-4894
Practice Address - Street 1:7737 E BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-5902
Practice Address - Country:US
Practice Address - Phone:423-892-2422
Practice Address - Fax:423-892-4894
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT639152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3594186Medicare ID - Type Unspecified
TNT61176Medicare UPIN
TN0791290001Medicare NSC