MEDICARE: DR. YU-TAI 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	390200000X	Student in an Organized Health Care Education/Training Program
2	152W00000X	Optometrist	14647	CA

General Provider Information

NPI Number	:	1568725562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YU-TAI WU OD

Provider Business Mailing Address
First Line	:	4327 GOLDEN CENTER DR
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-6287
Country	:	US
Telephone Number	:	530-621-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4641 MISSOURI FLAT RD
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-6816
Country	:	US
Telephone Number	:	530-621-7700
Fax Number	:

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

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	06/02/2022

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