MEDICARE: LUM OPTOMETRY INC

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	12485	CA

General Provider Information

NPI Number	:	1518339530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUM OPTOMETRY INC

Provider Business Mailing Address
First Line	:	8940 FLANDERS DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-2825
Country	:	US
Telephone Number	:	619-655-0313
Fax Number	:

Provider Business Practice Location Address
First Line	:	2561 EL CAMINO REAL
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1202
Country	:	US
Telephone Number	:	760-730-7320
Fax Number	:	760-729-5169

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN LUM
Credential	:	O.D.
Telephone Number	:	619-655-0313

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	10/29/2015

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Directions to “LUM OPTOMETRY INC ” Practice Location

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