Provider Demographics
NPI:1285760645
Name:HUDSON, DIANE COWGER (OD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:COWGER
Last Name:HUDSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:COWGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1790 E. MARKET ST. STE 92
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-5112
Mailing Address - Country:US
Mailing Address - Phone:540-908-6726
Mailing Address - Fax:540-526-0032
Practice Address - Street 1:1790 E. MARKET ST. STE 92
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5112
Practice Address - Country:US
Practice Address - Phone:540-434-3937
Practice Address - Fax:540-526-0032
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601001785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09991OtherPTAN
VA106017OtherANTHEM BLUE CROSS
VAU26740Medicare UPIN