Healthcare Provider Details

I. General information

NPI: 1780666156
Provider Name (Legal Business Name): PAMELA I WU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
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
92604-2520
US

IV. Provider business mailing address

5414 WALNUT AVE STE. B
IRVINE CA
92604-2520
US

V. Phone/Fax

Practice location:
  • Phone: 949-262-9393
  • Fax: 949-262-9333
Mailing address:
  • Phone: 949-262-9393
  • Fax: 949-262-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: