Provider Demographics
NPI:1699189662
Name:UPHOLD, JUDITH ELAINE (OD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELAINE
Last Name:UPHOLD
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 1:160 WAYLAND SMITH DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-7500
Mailing Address - Country:US
Mailing Address - Phone:724-437-1300
Mailing Address - Fax:
Practice Address - Street 1:160 WAYLAND SMITH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-7500
Practice Address - Country:US
Practice Address - Phone:724-437-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002952152W00000X
WV2011IOD1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA379482VU5Medicare PIN