Healthcare Provider Details

I. General information

NPI: 1033023759
Provider Name (Legal Business Name): RONG FU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 REGENTS RD UNIT 1G
SAN DIEGO CA
92122-1343
US

IV. Provider business mailing address

8310 REGENTS RD UNIT 1G
SAN DIEGO CA
92122-1343
US

V. Phone/Fax

Practice location:
  • Phone: 702-769-3837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: