Provider Demographics
NPI:1194430074
Name:ANNESSA DU, O.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ANNESSA DU, O.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-696-6961
Mailing Address - Street 1:11030 GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-2463
Mailing Address - Country:US
Mailing Address - Phone:626-696-6961
Mailing Address - Fax:
Practice Address - Street 1:11346 MOUNTAIN VIEW AVE STE B
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3833
Practice Address - Country:US
Practice Address - Phone:909-796-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty