Provider Demographics
NPI:1295873271
Name:WU, SANDRA (OD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 S ROUTE 59
Mailing Address - Street 2:SUITE 118
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-0937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:618 S ROUTE 59
Practice Address - Street 2:SUITE 118
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-0937
Practice Address - Country:US
Practice Address - Phone:630-355-1269
Practice Address - Fax:630-355-1295
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL 9726OtherEYEMED