Provider Demographics
NPI:1871696179
Name:MICHAEL M JUDKINS AND ASSOCIATES, INC.
Entity type:Organization
Organization Name:MICHAEL M JUDKINS AND ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SPRING
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-626-7699
Mailing Address - Street 1:5331 ADAMS AVE PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4755
Mailing Address - Country:US
Mailing Address - Phone:385-626-7699
Mailing Address - Fax:385-626-7816
Practice Address - Street 1:5331 ADAMS AVE PKWY STE B
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4755
Practice Address - Country:US
Practice Address - Phone:385-626-7699
Practice Address - Fax:385-626-7816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT375535-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529378983004Medicaid