Provider Demographics
NPI:1386335503
Name:JUDD, EDGAR FERNANDO (OD)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:FERNANDO
Last Name:JUDD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 S 2475 W
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-1969
Mailing Address - Country:US
Mailing Address - Phone:435-393-5190
Mailing Address - Fax:
Practice Address - Street 1:1251 NORTHFIELD RD STE 215
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-8623
Practice Address - Country:US
Practice Address - Phone:435-865-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13396875-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist