Provider Demographics
NPI:1588725063
Name:HUDSON OPTICAL
Entity type:Organization
Organization Name:HUDSON OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:PARUPSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-386-8401
Mailing Address - Street 1:1801 WARD AVE
Mailing Address - Street 2:SUITE 264 PLAZA94
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-2119
Mailing Address - Country:US
Mailing Address - Phone:715-386-8401
Mailing Address - Fax:
Practice Address - Street 1:1801 WARD AVE
Practice Address - Street 2:SUITE 264 PLAZA94
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-2119
Practice Address - Country:US
Practice Address - Phone:715-386-8401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIG0495Medicare UPIN