Provider Demographics
NPI:1093257453
Name:WU, JUSTIN (OD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13443 MAPLE AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4695
Mailing Address - Country:US
Mailing Address - Phone:718-886-8830
Mailing Address - Fax:718-886-8825
Practice Address - Street 1:14355 41ST AVE APT 5C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1821
Practice Address - Country:US
Practice Address - Phone:718-886-8830
Practice Address - Fax:718-886-8825
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist