Provider Demographics
NPI:1356342166
Name:LAU, DAVID J (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:LAU
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 1:7547 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4720
Mailing Address - Country:US
Mailing Address - Phone:916-965-1017
Mailing Address - Fax:
Practice Address - Street 1:7547 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4720
Practice Address - Country:US
Practice Address - Phone:916-965-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7981TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12975OtherMEDICAL EYE SERVICES
CA211705OtherEYEMED
T10630Medicare UPIN
EF392ZMedicare PIN
CA0514220001Medicare NSC