Judisch Vision PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

02262 Issued in IA

Legal business name

JUDISCH VISION PC

Doing business as

Rock Judisch Vision Clinic PC

Practice address

1341 W Main St
Lake City, IA 51449-0124

Phone

(712) 464-3136

Fax

(712) 464-7683

NPI assigned

Jan 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jonathan Paul Judisch, ODNPI 1285784280

Title

President

Phone

(712) 464-3136

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Rock Judisch Vision Clinic PC Doing business as

Medicare fee-for-service enrollment

Enrolled in IA2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Judisch Vision PC

  • Optometrist
  • Lake View, IA
  • NPI 1427103902

  1658269253

  Same PAC ID
• Judisch Vision PC

  • Optometrist
  • Gowrie, IA
  • NPI 1689725582

  1658269253

  Same PAC ID

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Judisch Vision PC

  • Optometrist
  • Lake View, IA
  • NPI 1427103902

  O20040305000787

  Same enrollment
• Judisch Vision PC

  • Optometrist
  • Gowrie, IA
  • NPI 1689725582

  O20040305000787

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Rock Vision Clinic PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Judisch Vision PC

  • Optometrist
  • Lake View, IA
  • NPI 1427103902
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jonathan Paul Judisch, OD

  • Optometrist
  • Lake City, IA
  • NPI 1285784280
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704844800000",
    "number": "1669521027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1341 W MAIN ST",
            "address_2": "PO BOX 124",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514490124",
            "telephone_number": "712-464-3136",
            "fax_number": "712-464-7683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1341 W MAIN ST",
            "city": "LAKE CITY",
            "state": "IA",
            "postal_code": "514490124",
            "telephone_number": "712-464-3136",
            "fax_number": "712-464-7683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUDISCH VISION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A",
        "authorized_official_last_name": "JUDISCH",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "712-464-3136",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "02262",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "1862",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0258194",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DA3268",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "25819",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rock Judisch Vision Clinic PC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rock Judisch Vision Clinic PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rueger J Holmgaard
• Audrey P Hood, T-LMHC
• Susan A Hornback, DO
• Megan M Huster
• Jeremy C Johnson, CRNA
• Jonathan Paul Judisch, OD
• Jeremie Lee Kent
• Yotin Keonin, MD
• Julie R Kraft, RPH
• Larry Lee Kruthoff, RPH

• Optometrist in Lake City, IA
• Providers in Lake City, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.