Provider Demographics
NPI:1750518346
Name:HUDSON, TYLER ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ROBERT
Last Name:HUDSON
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 1:2343 ANTOINETTE WAY
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-7405
Mailing Address - Country:US
Mailing Address - Phone:812-584-8515
Mailing Address - Fax:
Practice Address - Street 1:2343 ANTOINETTE WAY
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-7405
Practice Address - Country:US
Practice Address - Phone:812-584-8515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003584A152W00000X
OH5870152W00000X
KY1788DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3096984Medicaid