Provider Demographics
NPI:1699826230
Name:LU, CHAULOAN (OD)
Entity Type:Individual
Prefix:
First Name:CHAULOAN
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5545 CANOGA AVE
Mailing Address - Street 2:#112
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367
Mailing Address - Country:US
Mailing Address - Phone:714-723-8262
Mailing Address - Fax:
Practice Address - Street 1:321 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401
Practice Address - Country:US
Practice Address - Phone:310-394-2127
Practice Address - Fax:310-394-0111
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12964152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP12964Medicare ID - Type Unspecified