MEDICARE: DR. VIVIAN LU 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	009420	NY

General Provider Information

NPI Number	:	1720651938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIAN LU OD

Provider Business Mailing Address
First Line	:	11103 ROCKAWAY ST
Second Line	:
City	:	MALTA
State	:	NY
Zip	:	12020-5226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3039 ROUTE 50
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2937
Country	:	US
Telephone Number	:	518-580-1117
Fax Number	:

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

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	07/23/2021

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