Provider Demographics
NPI:1386740918
Name:HUMENANSKI, JUDITH (OD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:HUMENANSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:PA
Mailing Address - Zip Code:17752
Mailing Address - Country:US
Mailing Address - Phone:570-547-6233
Mailing Address - Fax:
Practice Address - Street 1:SUSQUEHANNA VALLEY MALL DRIVE
Practice Address - Street 2:SUITE 2 - BOSCOV'S OPTICAL CENTER
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1295
Practice Address - Country:US
Practice Address - Phone:570-374-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE006677P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist