Provider Demographics
NPI:1457447062
Name:HUDKINS, JOHN D (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:HUDKINS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:4008 S ELM PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-2021
Mailing Address - Country:US
Mailing Address - Phone:918-455-2020
Mailing Address - Fax:918-455-4030
Practice Address - Street 1:4008 S ELM PL
Practice Address - Street 2:SUITE A
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-2021
Practice Address - Country:US
Practice Address - Phone:918-455-2020
Practice Address - Fax:918-455-4030
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK909152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100766680AMedicaid
OKE066OtherBLUELINCS
OK0582850001Medicare NSC
OK100766680AMedicaid