Provider Demographics
NPI:1447288790
Name:MOON, JUDSON (OD)
Entity type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:
Last Name:MOON
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 1:57 KINGS HWY E
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2001
Mailing Address - Country:US
Mailing Address - Phone:856-427-0788
Mailing Address - Fax:856-216-9032
Practice Address - Street 1:57B KINGS HWY E
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2001
Practice Address - Country:US
Practice Address - Phone:856-427-0788
Practice Address - Fax:856-216-9032
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00038100152W00000X
NJ27OA00448100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU26926Medicare UPIN
NJMO521614Medicare ID - Type Unspecified