Provider Demographics
NPI:1578619615
Name:DAVID J LAU & WESLEY S UMEDA PTR
Entity Type:Organization
Organization Name:DAVID J LAU & WESLEY S UMEDA PTR
Other - Org Name:FAIR OAKS OPTOMETRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:UMEDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-965-1017
Mailing Address - Street 1:7547 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4720
Mailing Address - Country:US
Mailing Address - Phone:916-965-1017
Mailing Address - Fax:
Practice Address - Street 1:7547 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4720
Practice Address - Country:US
Practice Address - Phone:916-965-1017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8039TPL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEE412AMedicare PIN
CA0514220001Medicare NSC