Organization
JUDISCH VISION PC
Active
Other names
Rock Judisch Vision Clinic PC
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN PAUL JUDISCH OD (PRESIDENT)
(712) 464-3136
Entity
Organization
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
152W00000X
Optometrist
1862
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0258194
—
IA
01
—
25819
BCBS
—
01
—
DA3268
RR MEDICARE
—
Enumeration date
01/08/2007
Last updated
01/10/2024
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