Healthcare Provider Details

I. General information

NPI: 1437718210
Provider Name (Legal Business Name): JASON WU OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 MOUNT HOLLY RD
BURLINGTON NJ
08016-4158
US

IV. Provider business mailing address

1023 WATKINS ST
PHILADELPHIA PA
19148-1653
US

V. Phone/Fax

Practice location:
  • Phone: 609-386-5916
  • Fax: 609-386-8023
Mailing address:
  • Phone: 610-757-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003564
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00704400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number192622
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: