Healthcare Provider Details

I. General information

NPI: 1235207127
Provider Name (Legal Business Name): PAMELA I. WU O.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5414 WALNUT AVE STE B
IRVINE CA
92604-2522
US

IV. Provider business mailing address

5414 WALNUT AVE SUITE B
IRVINE CA
92604-2520
US

V. Phone/Fax

Practice location:
  • Phone: 949-262-9393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10925T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number10925T
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number10925T
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number10925T
License Number StateCA

VIII. Authorized Official

Name: DR. PAMELA WU
Title or Position: PRESIDENT
Credential: OD
Phone: 949-262-9393