Provider Demographics
NPI:1659943736
Name:JUDD, VERLE (OD)
Entity Type:Individual
Prefix:
First Name:VERLE
Middle Name:
Last Name:JUDD
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 1:8889 JEWELLA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2138
Mailing Address - Country:US
Mailing Address - Phone:318-686-5227
Mailing Address - Fax:
Practice Address - Street 1:8889 JEWELLA AVE STE D
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2138
Practice Address - Country:US
Practice Address - Phone:903-319-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1934-870AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist