Provider Demographics
NPI:1639122526
Name:HUDSON, ALLAN JAY (OD)
Entity Type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:JAY
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 1:340 NW BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1836
Mailing Address - Country:US
Mailing Address - Phone:541-416-2020
Mailing Address - Fax:541-447-2608
Practice Address - Street 1:404 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1627
Practice Address - Country:US
Practice Address - Phone:541-923-2221
Practice Address - Fax:541-923-3776
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1541AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR236083Medicaid
ORR139478Medicare PIN
OR236083Medicaid
OR5770620001Medicare NSC