Provider Demographics
NPI:1780882175
Name:FU, MIKA EVE (OD)
Entity type:Individual
Prefix:DR
First Name:MIKA
Middle Name:EVE
Last Name:FU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1699 TRENTON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1074
Mailing Address - Country:US
Mailing Address - Phone:714-851-0924
Mailing Address - Fax:
Practice Address - Street 1:151 S LAS POSAS RD
Practice Address - Street 2:SUITE 171
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2471
Practice Address - Country:US
Practice Address - Phone:760-510-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAN929GMedicare UPIN