Provider Demographics
NPI:1396709234
Name:HUDAK, DONALD T (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:T
Last Name:HUDAK
Suffix:
Gender:M
Credentials:MD
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:812-496-8782
Mailing Address - Fax:812-539-1800
Practice Address - Street 1:374 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-7038
Practice Address - Country:US
Practice Address - Phone:812-496-8782
Practice Address - Fax:812-539-1800
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.081767207W00000X, 207WX0200X
KY42414207W00000X, 207WX0200X
IN01049786A207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2424022Medicaid
KY64064462Medicaid
OHP00443351OtherRR MEDICARE
000000533203OtherANTHEM BC/BS
PA1011062680001Medicaid
OH4188493Medicare PIN
PA1011062680001Medicaid
000000533203OtherANTHEM BC/BS
OHP00443351OtherRR MEDICARE
OH4188496Medicare PIN
KY64064462Medicaid