Provider Demographics
NPI:1609959436
Name:KUDER, DENISE M (OD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:M
Last Name:KUDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35901 CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1069
Mailing Address - Country:US
Mailing Address - Phone:440-937-4765
Mailing Address - Fax:
Practice Address - Street 1:35901 CHESTER RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1069
Practice Address - Country:US
Practice Address - Phone:440-937-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4760/ T1564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000199218OtherANTHEM BC BS
OH000000199218OtherANTHEM BC BS