Provider Demographics
NPI:1952629982
Name:JULIA WEN OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JULIA WEN OD A PROFESSIONAL CORPORATION
Other - Org Name:GOLDEN VISION OPTOMETRY OF CUPERTINO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-996-9886
Mailing Address - Street 1:10123 N WOLFE RD STE 2138
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2523
Mailing Address - Country:US
Mailing Address - Phone:408-996-9886
Mailing Address - Fax:408-996-9877
Practice Address - Street 1:10123 N WOLFE RD STE 2138
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2523
Practice Address - Country:US
Practice Address - Phone:408-996-9886
Practice Address - Fax:408-996-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11976152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA113755Medicare PIN