Provider Demographics
NPI:1356410609
Name:RUDMIN, GERRARD (OD)
Entity type:Individual
Prefix:
First Name:GERRARD
Middle Name:
Last Name:RUDMIN
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 166
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:ME
Mailing Address - Zip Code:04930-0166
Mailing Address - Country:US
Mailing Address - Phone:207-924-3444
Mailing Address - Fax:207-924-5627
Practice Address - Street 1:81 SPRING ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-1511
Practice Address - Country:US
Practice Address - Phone:207-924-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT604152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1042368OtherAETNA
ME024257OtherANTHEM BC/BS
ME0179430001Medicare NSC
ME024257OtherANTHEM BC/BS
ME1042368OtherAETNA