Provider Demographics
NPI:1558896795
Name:MUDIE, LUCY (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:
Last Name:MUDIE
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF OPHTHALMOLOGY BAYLOR COLLEGE OF MEDICINE
Mailing Address - Street 2:1977 BUTLER BLVD., E2.201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-798-5143
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF OPHTHALMOLOGY BAYLOR COLLEGE OF MEDICINE
Practice Address - Street 2:1977 BUTLER BLVD., E2.201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-798-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0007749207W00000X
TXT6654207WX0200X, 207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program