Provider Demographics
NPI:1821067505
Name:WU, NANCY PARK (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:PARK
Last Name:WU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:22735 SPARROWDELL DR
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1818
Mailing Address - Country:US
Mailing Address - Phone:310-430-0586
Mailing Address - Fax:
Practice Address - Street 1:1275 AIRPORT PARK BLVD
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-7400
Practice Address - Country:US
Practice Address - Phone:707-313-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12473TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV00614Medicare UPIN