Active NPI
Mark A Judd, O.D.
- Optometrist
- Topeka, KS
National Provider Identifier
1376511758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1484-3
- Practice address
- 1400 SW Huntoon St
Topeka, KS 66604-1231 - Phone
- (785) 861-8800
- Fax
- (785) 478-5991
- NPI assigned
- Mar 10, 2006
- Last updated
- Nov 22, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1484-3 | KS | Primary |
Addresses
Primary practice location
1400 SW Huntoon St
Topeka, KS 66604-1231
Mailing address
1701 K 96 Hwy
Great Bend, KS 67530-3014
Phone (620) 792-8733
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 065133 | Other | KS | BLUE CROSS |
| 100280160F | Medicaid | KS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1484-3 | KS | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gracemed Health Clinic, Inc | Past | Accepting new patients | |
| Grene Vision Group LLC | Optometrist | Past | Accepting new patients |
| Grene Vision Group LLC | Optometrist | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Federally Qualified Health Center (FQHC)
- Wichita, KS
- NPI 1184691693
-
dba GraceMed Capitol Family Clinic
- Federally Qualified Health Center (FQHC)
- Topeka, KS
- NPI 1194174482
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574380800000",
"number": "1376511758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1701 K 96 HWY",
"city": "GREAT BEND",
"state": "KS",
"postal_code": "675303014",
"telephone_number": "620-792-8733",
"fax_number": "620-792-3621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 SW HUNTOON ST",
"city": "TOPEKA",
"state": "KS",
"postal_code": "666041231",
"telephone_number": "785-861-8800",
"fax_number": "785-478-5991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUDD",
"first_name": "MARK",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-10",
"last_updated": "2019-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "KS",
"license": "1484-3",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "065133",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100280160F",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Topeka, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.