Provider Demographics
NPI:1740629294
Name:LUCY WUN OD, INC
Entity type:Organization
Organization Name:LUCY WUN OD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-725-1900
Mailing Address - Street 1:10525 S DE ANZA BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4456
Mailing Address - Country:US
Mailing Address - Phone:408-725-1900
Mailing Address - Fax:
Practice Address - Street 1:10525 S DE ANZA BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-4456
Practice Address - Country:US
Practice Address - Phone:408-725-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11325T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty