Individual
JONATHAN PAUL JUDISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1341 W MAIN ST, LAKE CITY, IA 51449-0124
(712) 464-3136
(712) 464-7683
Mailing address
1341 W MAIN ST, PO BOX 124, LAKE CITY, IA 51449-0124
(712) 464-3136
(712) 464-7683
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02262
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0418657
—
IA
05
—
10025030700
—
NE
01
—
35539
BCBS
IA
01
—
P00052944
RR MEDICARE
—
Enumeration date
01/11/2007
Last updated
01/08/2010
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