Provider Demographics
NPI:1467025791
Name:WU, KAREN LY (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LY
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 1:78 TALLOWOOD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3113
Mailing Address - Country:US
Mailing Address - Phone:408-500-5621
Mailing Address - Fax:
Practice Address - Street 1:78 TALLOWOOD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3113
Practice Address - Country:US
Practice Address - Phone:408-500-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34863152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist