Provider Demographics
NPI:1073891818
Name:WU, CHRISTINE CHANG (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CHANG
Last Name:WU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1380 FULLERTON RD
Mailing Address - Street 2:#103
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1248
Mailing Address - Country:US
Mailing Address - Phone:626-839-0908
Mailing Address - Fax:
Practice Address - Street 1:1380 FULLERTON RD
Practice Address - Street 2:#103
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-1248
Practice Address - Country:US
Practice Address - Phone:626-839-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14260152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist