Individual
DR. JEROME SUDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3510 MANCHESTER RD, COVENTRY TOWNSHIP, OH 44319-1415
(330) 753-2100
(330) 633-7165
Mailing address
PO BOX 207170, DALLAS, TX 75320-2117
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3046/T812
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000134329
ANTHEM
OH
05
—
0505046
—
OH
01
—
0655759
AETNA HMO
OH
01
—
1418274
UNITED HEALTHCARE
OH
01
—
341572960B
SUMMA
OH
01
—
410022025
RAILROAD MEDICARE
OH
01
—
4338408
AETNA PPO
OH
01
—
728946
BUCKEYE
OH
Enumeration date
05/24/2005
Last updated
06/08/2021
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