Provider Demographics
NPI:1851484893
Name:RUDNICK, STEPHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:RUDNICK
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 1:1036 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1210
Mailing Address - Country:US
Mailing Address - Phone:570-421-2680
Mailing Address - Fax:570-421-2713
Practice Address - Street 1:1036 N 9TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1210
Practice Address - Country:US
Practice Address - Phone:570-421-2680
Practice Address - Fax:570-421-2713
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG000650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T29348Medicare UPIN
127487QG7Medicare PIN