Provider Demographics
NPI:1780666156
Name:WU, PAMELA I (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:I
Last Name:WU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5414 WALNUT AVE
Mailing Address - Street 2:STE. B
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2520
Mailing Address - Country:US
Mailing Address - Phone:949-262-9393
Mailing Address - Fax:949-262-9333
Practice Address - Street 1:5414 WALNUT AVE
Practice Address - Street 2:STE. B
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-2520
Practice Address - Country:US
Practice Address - Phone:949-262-9393
Practice Address - Fax:949-262-9333
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10925T152WC0802X, 152WL0500X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD109250OtherMEDICAL
CASD109250OtherMEDICAL
CAU70176Medicare UPIN