Individual
JONATHAN ALAN GUDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
101 W 4TH ST, SALEM, VA 24153-3638
(540) 387-1183
Mailing address
101 W 4TH ST, SALEM, VA 24153-3638
(540) 387-1183
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000618
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410049826
PALMETTO GBA
VA
01
—
461361
ANTHEM
VA
01
—
4715110001
ADMINISTAR FEDERAL
VA
05
—
9237216
—
VA
Enumeration date
09/12/2005
Last updated
09/26/2011
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