Individual
MARC A HUDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
152W00000X
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009235728
—
VA
01
—
106018
ANTHEM PROVIDER NUMBER
VA
Enumeration date
12/07/2005
Last updated
04/24/2009
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