Provider Demographics
NPI:1710122312
Name:LU, TIFFANY YI-TIN (O D)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:YI-TIN
Last Name:LU
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 1:1009 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-3901
Mailing Address - Country:US
Mailing Address - Phone:916-442-4927
Mailing Address - Fax:916-442-4928
Practice Address - Street 1:1009 12TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-3901
Practice Address - Country:US
Practice Address - Phone:916-442-4927
Practice Address - Fax:916-442-4928
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13388T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist