Provider Demographics
NPI:1740351105
Name:LAU, SPENCER (OD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:
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 1:811 SANTA CRUZ AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4609
Mailing Address - Country:US
Mailing Address - Phone:650-326-2177
Mailing Address - Fax:650-326-8154
Practice Address - Street 1:811 SANTA CRUZ AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4609
Practice Address - Country:US
Practice Address - Phone:650-326-2177
Practice Address - Fax:650-326-8154
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10360T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU80364Medicare UPIN