Provider Demographics
NPI:1043267537
Name:ELSON, JUDITH F (OD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:F
Last Name:ELSON
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 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:1482 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5911
Practice Address - Country:US
Practice Address - Phone:203-254-0055
Practice Address - Fax:203-256-1284
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA090002133CT01OtherBLUECROSS BLUESHIELD
CA004209806Medicaid
410028954OtherRAILROAD MEDICARE
CA090002133CT01OtherBLUECROSS BLUESHIELD
410000700Medicare ID - Type Unspecified