Provider Demographics
NPI:1164546487
Name:LOU, DIANA LUCRECIA (OD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LUCRECIA
Last Name:LOU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 STEINBECK CT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1832
Mailing Address - Country:US
Mailing Address - Phone:949-551-2517
Mailing Address - Fax:626-444-8522
Practice Address - Street 1:10906 VALLEY MALL
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2616
Practice Address - Country:US
Practice Address - Phone:626-579-2020
Practice Address - Fax:626-444-8522
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9988T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist