Provider Demographics
NPI:1306831649
Name:LUU, CHARLES CAM (O D)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CAM
Last Name:LUU
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17430 SUMMER OAK PL
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-9001
Mailing Address - Country:US
Mailing Address - Phone:714-993-7734
Mailing Address - Fax:
Practice Address - Street 1:9191 BOLSA AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5564
Practice Address - Country:US
Practice Address - Phone:714-892-4171
Practice Address - Fax:714-891-3886
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8628T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT95600Medicare UPIN
CAWOP8628AMedicare ID - Type UnspecifiedMEMBER ID NUMBER