Healthcare Provider Details

I. General information

NPI: 1760704803
Provider Name (Legal Business Name): THEODORE LYU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 BROADWAY
ELMHURST NY
11373-1329
US

IV. Provider business mailing address

79-01 BROADWAY OPHTHALMOLOGY, H249A
ELMHURST NY
11373
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-2020
  • Fax:
Mailing address:
  • Phone: 718-334-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number262034
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: