Provider Demographics
NPI:1609502715
Name:TSUI, JEREMY WING-LEUNG (OD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:WING-LEUNG
Last Name:TSUI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 AZEVEDO CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6201
Mailing Address - Country:US
Mailing Address - Phone:408-338-5768
Mailing Address - Fax:
Practice Address - Street 1:613 AZEVEDO CT
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-6201
Practice Address - Country:US
Practice Address - Phone:408-338-5768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35146152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist