| |
1341 W Main St, Lake City, IA 51449-0124 | |
(712) 464-3136 | |
(712) 464-7683 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 1341 W Main St, Lake City, Iowa |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1669521027 | NPI | - | NPPES |
0258194 | Medicaid | IA | |
DA3268 | Other | RR MEDICARE | |
25819 | Other | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 02262 (Iowa) | Primary |
152W00000X | Optometrist | 1862 (Iowa) | Secondary |
Provider Name | Jonathan Paul Judisch |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1285784280 PECOS PAC ID: 8426189754 Enrollment ID: I20100629000960 |
Mailing Address | Practice Location Address |
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1341 W Main St, Po Box 124, Lake City, IA 51449-0124 Ph: (712) 464-3136 | 1341 W Main St, Lake City, IA 51449-0124 Ph: (712) 464-3136 |
Jonathan Paul Judisch, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 1341 W Main St, Lake City, IA 51449 Phone: 712-464-3136 Fax: 712-464-7683 |