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General NPI Number Information
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NPI Number | 1740629294
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Entity Type | Organization
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Legal Business Name | LUCY WUN OD, INC
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 06/18/2013
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Provider Practice Location Address
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Address Line | 10525 S DE ANZA BLVD SUITE 190
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City | CUPERTINO
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State | CA
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Zip | 95014-4456
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Country | US
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Telephone | 408-725-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 10525 S DE ANZA BLVD SUITE 190
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City | CUPERTINO
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State | CA
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Zip | 95014-4456
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Country | US
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Telephone | 408-725-1900
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | LUCY LIU
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Credential |
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Telephone | 408-725-1900
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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 | 11325T
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License Number State | CA
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