Provider Demographics
NPI:1942536073
Name:LU OPTOMETRY
Entity Type:Organization
Organization Name:LU OPTOMETRY
Other - Org Name:CAPITOL OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:YI-TIN
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:916-442-4927
Mailing Address - Street 1:1009 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-3901
Mailing Address - Country:US
Mailing Address - Phone:916-442-4927
Mailing Address - Fax:916-442-4928
Practice Address - Street 1:1009 12TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-3901
Practice Address - Country:US
Practice Address - Phone:916-442-4927
Practice Address - Fax:916-442-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-24
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13388T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty