MEDICARE: DR. MONTY WU OD

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	11407T	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OP11407	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1184767261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONTY WU OD

Provider Business Mailing Address
First Line	:	1239 E VALLEY BLVD
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91801-5235
Country	:	US
Telephone Number	:	626-289-2021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1239 E VALLEY BLVD
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91801-5235
Country	:	US
Telephone Number	:	626-391-7172
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	10/16/2025

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