Provider Demographics
NPI:1215468525
Name:WU, CONNIE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1134
Mailing Address - Country:US
Mailing Address - Phone:305-243-2020
Mailing Address - Fax:305-482-4568
Practice Address - Street 1:900 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1134
Practice Address - Country:US
Practice Address - Phone:305-243-2020
Practice Address - Fax:305-482-4568
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD473221207W00000X, 207WX0009X
390200000X
FLME154709207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program