Provider Demographics
NPI:1679658009
Name:REN, XIAO-OU (O D)
Entity Type:Individual
Prefix:MS
First Name:XIAO-OU
Middle Name:
Last Name:REN
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GALES DR # B
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-2924
Mailing Address - Country:US
Mailing Address - Phone:908-531-8272
Mailing Address - Fax:
Practice Address - Street 1:1515 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6509
Practice Address - Country:US
Practice Address - Phone:908-769-6421
Practice Address - Fax:908-769-7931
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO 00139800152W00000X
NJOA 00601200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist