Healthcare Provider Details

I. General information

NPI: 1487304911
Provider Name (Legal Business Name): PEISHAN WU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PEI SHAN WU OD

II. Dates (important events)

Enumeration Date: 03/27/2022
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 MONTEREY AVE STE 3
LOS GATOS CA
95030-5319
US

IV. Provider business mailing address

431 MONTEREY AVE STE 3
LOS GATOS CA
95030-5319
US

V. Phone/Fax

Practice location:
  • Phone: 408-354-9510
  • Fax: 408-395-1610
Mailing address:
  • Phone:
  • Fax: 408-395-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT35205TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: