Provider Demographics
NPI:1659410819
Name:WUN, LUCY (ODO)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:WUN
Suffix:
Gender:F
Credentials:ODO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10525 S DE ANZA BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4448
Mailing Address - Country:US
Mailing Address - Phone:408-725-1900
Mailing Address - Fax:408-725-1989
Practice Address - Street 1:10525 S DE ANZA BLVD STE 190
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-4448
Practice Address - Country:US
Practice Address - Phone:408-725-1900
Practice Address - Fax:408-725-1989
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11325T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist