Provider Demographics
NPI:1306828454
Name:LUI, TERESA J (OD INC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:J
Last Name:LUI
Suffix:
Gender:F
Credentials:OD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:616 RAMONA ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2577
Mailing Address - Country:US
Mailing Address - Phone:650-321-9525
Mailing Address - Fax:805-866-6069
Practice Address - Street 1:616 RAMONA ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2577
Practice Address - Country:US
Practice Address - Phone:650-321-9525
Practice Address - Fax:805-866-6069
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0077220Medicare UPIN
CAGA909AMedicare PIN