MEDICARE: DR. JUN FU 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	4901003816	MI

General Provider Information

NPI Number	:	1558428615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUN FU O,D,

Provider Business Mailing Address
First Line	:	2934 SANTIA DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-3982
Country	:	US
Telephone Number	:	248-879-6845
Fax Number	:	248-853-1641

Provider Business Practice Location Address
First Line	:	3160 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5040
Country	:	US
Telephone Number	:	248-853-4141
Fax Number	:	248-853-1641

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

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	07/08/2007

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