MEDICARE: DR. ROGER L. WU O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	10971T	CA

General Provider Information

NPI Number	:	1063400604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER L. WU O.D.

Provider Business Mailing Address
First Line	:	2707 E VALLEY BLVD
Second Line	:	SUITE 216
City	:	WEST COVINA
State	:	CA
Zip	:	91792-3195
Country	:	US
Telephone Number	:	626-810-3398
Fax Number	:	626-810-3342

Provider Business Practice Location Address
First Line	:	2707 E VALLEY BLVD
Second Line	:	SUITE 216
City	:	WEST COVINA
State	:	CA
Zip	:	91792-3195
Country	:	US
Telephone Number	:	626-810-3398
Fax Number	:	626-810-3342

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	10/28/2015

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