Provider Demographics
NPI:1134292121
Name:PASADENA EYE MEDICAL GROUP
Entity Type:Organization
Organization Name:PASADENA EYE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MERIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-796-5325
Mailing Address - Street 1:10 CONGRESS ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3023
Mailing Address - Country:US
Mailing Address - Phone:626-796-5325
Mailing Address - Fax:626-796-5526
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:SUITE 340
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3023
Practice Address - Country:US
Practice Address - Phone:626-796-5325
Practice Address - Fax:626-796-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ79446ZMedicaid
CA00A243881Medicaid
CAW2157Medicare ID - Type UnspecifiedWU YU RIFFENBURGH MCARE
CAA30219Medicare UPIN
CA00A243881Medicaid
CAZZZ79446ZMedicaid
CAF26163Medicare UPIN
CAA24388Medicare ID - Type UnspecifiedBOWNS MCARE