Provider Demographics
NPI:1063400604
Name:WU, ROGER L (OD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:L
Last Name:WU
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Gender:M
Credentials:OD
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Mailing Address - Street 1:2707 E VALLEY BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-3195
Mailing Address - Country:US
Mailing Address - Phone:626-810-3398
Mailing Address - Fax:626-810-3342
Practice Address - Street 1:2707 E VALLEY BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3195
Practice Address - Country:US
Practice Address - Phone:626-810-3398
Practice Address - Fax:626-810-3342
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2015-10-28
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Provider Licenses
StateLicense IDTaxonomies
CA10971T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU98657Medicare UPIN