=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285520833
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HTOO HTOO LU OD PROF CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2025
-----------------------------------------------------
Last Update Date | 08/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 855 LAKEVILLE ST STE 102
-----------------------------------------------------
City | PETALUMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94952-7328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-763-1423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37036 ALEXANDER ST
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94536-6502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-557-8486
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HTOO HTOO LU
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 510-557-8486
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------