Provider Demographics
NPI:1487615704
Name:JUDD, THOMAS AARON (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:AARON
Last Name:JUDD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:6091 S POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4899
Mailing Address - Country:US
Mailing Address - Phone:239-466-3111
Mailing Address - Fax:239-466-9499
Practice Address - Street 1:15640 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4168
Practice Address - Country:US
Practice Address - Phone:239-466-3111
Practice Address - Fax:239-466-9499
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC 4141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00369128OtherRAIL ROAD MEDICARE
FLP00369128OtherRAIL ROAD MEDICARE