Provider Demographics
NPI:1710652714
Name:LAU, ALYSSA MEGAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:MEGAN
Last Name:LAU
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 1:1121 40TH ST APT 3303
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3750
Mailing Address - Country:US
Mailing Address - Phone:808-284-1915
Mailing Address - Fax:
Practice Address - Street 1:395 CIVIC DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1979
Practice Address - Country:US
Practice Address - Phone:925-676-8365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty