MEDICARE: AUDREY LU 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	2014021050	MO

General Provider Information

NPI Number	:	1801202387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY LU O.D.

Provider Business Mailing Address
First Line	:	8560 CHURCH RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64157-1202
Country	:	US
Telephone Number	:	816-479-5899
Fax Number	:

Provider Business Practice Location Address
First Line	:	8560 CHURCH RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64157-1202
Country	:	US
Telephone Number	:	816-479-5899
Fax Number	:

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

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	03/01/2016

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