Provider Demographics
NPI:1831106491
Name:WOO, DERRICK EN-PEI (OD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:EN-PEI
Last Name:WOO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5532 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1535
Mailing Address - Country:US
Mailing Address - Phone:562-867-2020
Mailing Address - Fax:562-867-6100
Practice Address - Street 1:5532 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1535
Practice Address - Country:US
Practice Address - Phone:562-867-2020
Practice Address - Fax:562-867-6100
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11781TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD117810Medicaid
CA026308745OtherVAP
CA026308745OtherVAP
CASD117810Medicaid
WY152Medicare ID - Type Unspecified