Provider Demographics
NPI:1801202387
Name:LU, AUDREY (OD)
Entity Type:Individual
Prefix:
First Name:AUDREY
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 1:8560 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-1202
Mailing Address - Country:US
Mailing Address - Phone:816-479-5899
Mailing Address - Fax:
Practice Address - Street 1:8560 CHURCH RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-1202
Practice Address - Country:US
Practice Address - Phone:816-479-5899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014021050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist