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General NPI Number Information
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NPI Number | 1265207716
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Entity Type | Individual
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Provider Name | DEREK YOU-CHUN WU OD
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Gender | Male
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 3001 WHITE BEAR AVE N STE 1050
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1290
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Country | US
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Telephone | 651-770-3923
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Fax |
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Provider Business Mailing Address
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Address Line | 3781 FAIRWAY DR
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City | WOODBURY
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State | MN
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Zip | 55125-5019
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Country | US
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Telephone | 651-269-5582
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3897
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License Number State | MN
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