Healthcare Provider Details

I. General information

NPI: 1710328745
Provider Name (Legal Business Name): JESSICA LU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2013
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 BARRANCA PKWY STE 240
IRVINE CA
92606-8231
US

IV. Provider business mailing address

3500 BARRANCA PKWY STE 240
IRVINE CA
92606-8231
US

V. Phone/Fax

Practice location:
  • Phone: 949-978-9696
  • Fax: 949-978-9797
Mailing address:
  • Phone: 949-978-9696
  • Fax: 949-978-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: