Provider Demographics
NPI:1427198589
Name:LU, BEN EI (OD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:EI
Last Name:LU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 S GRANDRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4936
Mailing Address - Country:US
Mailing Address - Phone:626-573-0793
Mailing Address - Fax:
Practice Address - Street 1:3043 FOOTHILL BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-2784
Practice Address - Country:US
Practice Address - Phone:818-957-8942
Practice Address - Fax:818-957-7804
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11014T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA118510OtherEYEMED #
CASD0110140Medicaid
CASD0110140Medicaid
CAU70569Medicare UPIN