Provider Demographics
NPI:1457628000
Name:LU, OANH HUYNH (OD)
Entity Type:Individual
Prefix:
First Name:OANH
Middle Name:HUYNH
Last Name:LU
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 1:17818 SE 136TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-7135
Mailing Address - Country:US
Mailing Address - Phone:917-587-4914
Mailing Address - Fax:
Practice Address - Street 1:420 W SMITH ST STE 105
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4447
Practice Address - Country:US
Practice Address - Phone:253-867-1616
Practice Address - Fax:253-867-1618
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002669152W00000X
WA61109395152W00000X
TN3011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist