Provider Demographics
NPI:1245481464
Name:HUGHES, JUDY JACKSON (OD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:JACKSON
Last Name:HUGHES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:DIANNE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4509 WARWICK LN
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5665
Mailing Address - Country:US
Mailing Address - Phone:512-586-3611
Mailing Address - Fax:
Practice Address - Street 1:1815 BROTHERS BLVD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5413
Practice Address - Country:US
Practice Address - Phone:979-695-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5179T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist