MEDICARE: DR. AMY NGOC LUU OD

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	152WC0802X	Corneal and Contact Management Optometrist	2702	OK
2	152WL0500X	Low Vision Rehabilitation Optometrist	2702	OK
3	152WP0200X	Pediatric Optometrist	2702	OK
4	152WS0006X	Sports Vision Optometrist	2702	OK
5	152WV0400X	Vision Therapy Optometrist	2702	OK
6	152WX0102X	Occupational Vision Optometrist	2702	OK

General Provider Information

NPI Number	:	1508144346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY NGOC LUU OD

Provider Business Mailing Address
First Line	:	2700 SW 29TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-1806
Country	:	US
Telephone Number	:	405-632-9749
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 SW 29TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-1806
Country	:	US
Telephone Number	:	405-632-9749
Fax Number	:

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

Provider Enumeration Date	:	07/27/2011
Last Update Date	:	03/01/2017

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