Gene D Prudhon, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1483 Issued in WI

Practice address

1005 17TH St
Brodhead, WI 53520-1855

Phone

(608) 897-2128

Fax

(608) 897-3937

NPI assigned

Sep 14, 2005

Last updated

Feb 8, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297123200000",
    "number": "1841285947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 17TH ST",
            "address_2": "PO BOX 137",
            "city": "BRODHEAD",
            "state": "WI",
            "postal_code": "535201855",
            "telephone_number": "608-897-2128",
            "fax_number": "608-897-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 17TH ST",
            "city": "BRODHEAD",
            "state": "WI",
            "postal_code": "535201855",
            "telephone_number": "608-897-2128",
            "fax_number": "608-897-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDHON",
        "first_name": "GENE",
        "middle_name": "D",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2011-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38545800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS & BLUESHIELD",
            "identifier": "391904576017",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCYCARE",
            "identifier": "PRUDHGEN",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS PLUS",
            "identifier": "1006622",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "1483",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• School District of Brodhead

• Optometrist in Brodhead, WI
• Providers in Brodhead, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.