Provider Demographics
NPI:1720319791
Name:LU, XIAO MENG (OD)
Entity Type:Individual
Prefix:
First Name:XIAO MENG
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:8650 GENESEE AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1134
Mailing Address - Country:US
Mailing Address - Phone:858-452-3299
Mailing Address - Fax:858-452-3290
Practice Address - Street 1:7007 FRIARS RD
Practice Address - Street 2:SUITE 667A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1148
Practice Address - Country:US
Practice Address - Phone:619-542-1794
Practice Address - Fax:619-542-1518
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2011-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13770 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist