Provider Demographics
NPI:1942277678
Name:DUDOW, IRWIN ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:ROBERT
Last Name:DUDOW
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:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91353-0366
Mailing Address - Country:US
Mailing Address - Phone:818-767-2050
Mailing Address - Fax:818-767-2056
Practice Address - Street 1:8101 SUNLAND BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3949
Practice Address - Country:US
Practice Address - Phone:818-767-2050
Practice Address - Fax:818-767-2056
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP4775TLG152WC0802X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0047750Medicaid
CAOP4775Medicare PIN
CAT69948Medicare UPIN
CAP01231065Medicare PIN