Provider Demographics
NPI:1518246883
Name:LU, YAN (OD)
Entity Type:Individual
Prefix:DR
First Name:YAN
Middle Name:
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 1:57 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-4327
Mailing Address - Country:US
Mailing Address - Phone:781-321-3820
Mailing Address - Fax:
Practice Address - Street 1:278 MIDDLESEX AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5066
Practice Address - Country:US
Practice Address - Phone:781-396-2322
Practice Address - Fax:781-396-3353
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist