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General NPI Number Information
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NPI Number | 1861578312
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Entity Type | Individual
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Provider Name | IDY S WU O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 04/19/2025
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Provider Practice Location Address
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Address Line | 1657 BATH AVE
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City | BROOKLYN
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State | NY
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Zip | 11214-4509
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Country | US
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Telephone | 718-331-1491
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Fax |
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Provider Business Mailing Address
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Address Line | 1657 BATH AVE
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City | BROOKLYN
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State | NY
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Zip | 11214-4509
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Country | US
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Telephone | 718-331-1491
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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 | TUV006988
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License Number State | NY
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