Provider Demographics
NPI:1629418728
Name:MU, ANDY YINGJU (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:YINGJU
Last Name:MU
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:11035 LAVENDER HILL DR
Mailing Address - Street 2:STE 160-288
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2957
Mailing Address - Country:US
Mailing Address - Phone:702-913-8406
Mailing Address - Fax:253-399-8410
Practice Address - Street 1:2390 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5084
Practice Address - Country:US
Practice Address - Phone:702-825-2085
Practice Address - Fax:702-852-5743
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV793152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1629418728Medicaid