Provider Demographics
NPI:1871666891
Name:DUDAK, MICHAEL G (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:DUDAK
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 1:34 OLD WOOD RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2409
Mailing Address - Country:US
Mailing Address - Phone:973-267-7500
Mailing Address - Fax:973-267-8485
Practice Address - Street 1:34 OLD WOOD RD
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2409
Practice Address - Country:US
Practice Address - Phone:973-267-7500
Practice Address - Fax:973-267-8485
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00347600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU54814Medicare UPIN
NJDU 651865Medicare ID - Type UnspecifiedMEDICARE PROVIDER #