Provider Demographics
NPI:1639166507
Name:HUDISH, CHERYL K (OD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:K
Last Name:HUDISH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:K
Other - Last Name:HUDISH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1465 LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545-9768
Mailing Address - Country:US
Mailing Address - Phone:717-879-6900
Mailing Address - Fax:717-879-6901
Practice Address - Street 1:1465 LANCASTER RD
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-9768
Practice Address - Country:US
Practice Address - Phone:717-879-6900
Practice Address - Fax:717-879-6901
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET008805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50217Medicaid
PA50217Medicaid
PA689730Medicare PIN