MEDICARE: DR. LUCY MUDIE MD MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	T6654	TX
2	207W00000X	Ophthalmology Physician	TL.0007749	CO
3	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	T6654	TX
4	390200000X	Student in an Organized Health Care Education/Training Program
5	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	73496	AZ

General Provider Information

NPI Number	:	1558896795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCY MUDIE MD MPH

Provider Business Mailing Address
First Line	:	698 E WETMORE RD STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-1752
Country	:	US
Telephone Number	:	520-790-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	698 E WETMORE RD STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-1752
Country	:	US
Telephone Number	:	520-790-8888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	01/12/2026

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