Provider Demographics
NPI:1376511758
Name:JUDD, MARK A (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:JUDD
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1701 K 96 HWY
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3014
Mailing Address - Country:US
Mailing Address - Phone:620-792-8733
Mailing Address - Fax:620-792-3621
Practice Address - Street 1:1400 SW HUNTOON ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1231
Practice Address - Country:US
Practice Address - Phone:785-861-8800
Practice Address - Fax:785-478-5991
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1484-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS065133OtherBLUE CROSS
KS100280160FMedicaid
KS065133OtherBLUE CROSS
KS651103Medicare PIN