MEDICARE: TIFFANY LU 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	152W00000X	Optometrist	5594	MA

General Provider Information

NPI Number	:	1609567189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY LU OD

Provider Business Mailing Address
First Line	:	215 THOMAS BURGIN PKWY UNIT 24
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-4220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 CENTRE ST
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2537
Country	:	US
Telephone Number	:	617-983-3937
Fax Number	:

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

Provider Enumeration Date	:	05/16/2023
Last Update Date	:	03/10/2026

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Directions to “ TIFFANY LU OD” Practice Location

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