Provider Demographics
NPI:1912045246
Name:LUM, RODNEY MERRITT (OD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:MERRITT
Last Name:LUM
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 1:439 KENTMERE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3272
Mailing Address - Country:US
Mailing Address - Phone:650-965-8694
Mailing Address - Fax:
Practice Address - Street 1:621 E CAMPBELL AVE
Practice Address - Street 2:SUITE 11-B
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2139
Practice Address - Country:US
Practice Address - Phone:408-378-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9300T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU27788Medicare UPIN