Provider Demographics
NPI:1922093269
Name:LOUIE LUU, LYNNE DIANNE (O D)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:DIANNE
Last Name:LOUIE LUU
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9351 BOLSA AVENUE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-494-1333
Mailing Address - Fax:
Practice Address - Street 1:9351 BOLSA AVENUE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-494-1333
Practice Address - Fax:714-463-4896
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8786T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922093269OtherMEDI-CAL
CA1922093269OtherMEDI-CAL
CAWOP8786DMedicare ID - Type UnspecifiedMEMBER ID NUMBER