Judisch, Jonathan Paul

Judisch, Jonathan Paul is an individual health care provider with primary practice located at 1341 W Main St , Lake City IA 51449-0124. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Judisch, Jonathan Paul can be contacted via phone (712) 464-3136.

Contact Information

Primary practice address
1341 W Main St Lake City IA 51449-0124
Phone: (712) 464-3136
Fax: (712) 464-7683
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 02262 Iowa

Profile Details

NPI number 1285784280
LBN Legal business name Judisch, Jonathan Paul
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2007
Last updated Jan 8th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285784280 NPPES
Nebraska MEDICAID 10025030700
Nebraska Other 35539
Nebraska MEDICAID 0418657
Nebraska Other P00052944

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