Provider Demographics
NPI:1487711867
Name:BABB, MADLYN WARD (OD)
Entity type:Individual
Prefix:DR
First Name:MADLYN
Middle Name:WARD
Last Name:BABB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5149
Mailing Address - Country:US
Mailing Address - Phone:432-697-7977
Mailing Address - Fax:
Practice Address - Street 1:3415 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5149
Practice Address - Country:US
Practice Address - Phone:432-697-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6769TG152W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81447QOtherBCBS
TX178621201Medicaid
TX178621202Medicaid
TX8F1331Medicare ID - Type UnspecifiedMON-MEDICARE
TX178621201Medicaid
TX81447QOtherBCBS