Provider Demographics
NPI:1265207716
Name:WU, DEREK YOU-CHUN (OD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:YOU-CHUN
Last Name:WU
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 1:3781 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-5019
Mailing Address - Country:US
Mailing Address - Phone:651-269-5582
Mailing Address - Fax:
Practice Address - Street 1:3001 WHITE BEAR AVE N STE 1050
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1290
Practice Address - Country:US
Practice Address - Phone:651-770-3923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist