Provider Demographics
NPI:1548405335
Name:LOUIE, AUDREY V (OD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:V
Last Name:LOUIE
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 1:37524 MARSTEN DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3699
Mailing Address - Country:US
Mailing Address - Phone:510-494-9184
Mailing Address - Fax:
Practice Address - Street 1:495 CASTRO ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-2086
Practice Address - Country:US
Practice Address - Phone:650-967-6649
Practice Address - Fax:650-967-0237
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13487T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist