Provider Demographics
NPI:1801855630
Name:TU, MANQIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MANQIAN
Middle Name:
Last Name:TU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:TU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:920 REVOLUTION ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3748
Practice Address - Country:US
Practice Address - Phone:410-939-2200
Practice Address - Fax:410-939-5980
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001427152W00000X
MDTA2455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92517Medicare UPIN
PADD2991Medicare ID - Type Unspecified