Provider Demographics
NPI:1275788952
Name:WU, EMILY (OD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:WU
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 1:1454 REEVES ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2939
Mailing Address - Country:US
Mailing Address - Phone:310-266-7097
Mailing Address - Fax:
Practice Address - Street 1:1454 REEVES ST APT 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2939
Practice Address - Country:US
Practice Address - Phone:310-266-7097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13676152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist