Provider Demographics
NPI:1649852120
Name:DU, JOANNE D (OD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:D
Last Name:DU
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 1:2159 ASHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-1204
Mailing Address - Country:US
Mailing Address - Phone:408-613-5954
Mailing Address - Fax:
Practice Address - Street 1:6815 CAMINO ARROYO STE 60
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7077
Practice Address - Country:US
Practice Address - Phone:408-900-2000
Practice Address - Fax:408-713-3046
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34922152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist