Provider Demographics
NPI:1336597962
Name:LUU, BECKY
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:LUU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 W 15TH ST STE A-110
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4737
Mailing Address - Country:US
Mailing Address - Phone:972-758-0625
Mailing Address - Fax:
Practice Address - Street 1:3801 W 15TH ST STE A-110
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4737
Practice Address - Country:US
Practice Address - Phone:972-758-0625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT225TAA40152W00000X
TX8889152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist