Healthcare Provider Details

I. General information

NPI: 1659410819
Provider Name (Legal Business Name): LUCY WUN O.DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10525 S DE ANZA BLVD STE 190
CUPERTINO CA
95014-4448
US

IV. Provider business mailing address

10525 S DE ANZA BLVD STE 190
CUPERTINO CA
95014-4448
US

V. Phone/Fax

Practice location:
  • Phone: 408-725-1900
  • Fax: 408-725-1989
Mailing address:
  • Phone: 408-725-1900
  • Fax: 408-725-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11325T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: