Provider Demographics
NPI:1053431254
Name:BUDDE, TIA NEWSOM (OD)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:NEWSOM
Last Name:BUDDE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:7155 OLD KATY RD
Mailing Address - Street 2:N100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2134
Mailing Address - Country:US
Mailing Address - Phone:713-668-6828
Mailing Address - Fax:832-280-3636
Practice Address - Street 1:5125 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3727
Practice Address - Country:US
Practice Address - Phone:713-477-6929
Practice Address - Fax:281-598-6475
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX4130T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist