Healthcare Provider Details

I. General information

NPI: 1942353263
Provider Name (Legal Business Name): SHELLEY MINGWEN WU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 ALAMO PLZ #D
ALAMO CA
94507-1531
US

IV. Provider business mailing address

215 ALAMO PLZ #D
ALAMO CA
94507-1531
US

V. Phone/Fax

Practice location:
  • Phone: 925-202-2846
  • Fax:
Mailing address:
  • Phone: 925-202-2846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT11981TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: