Provider Demographics
NPI:1558428615
Name:FU, JUN (O,D,)
Entity type:Individual
Prefix:DR
First Name:JUN
Middle Name:
Last Name:FU
Suffix:
Gender:M
Credentials:O,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 SANTIA DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3982
Mailing Address - Country:US
Mailing Address - Phone:248-879-6845
Mailing Address - Fax:248-853-1641
Practice Address - Street 1:3160 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5040
Practice Address - Country:US
Practice Address - Phone:248-853-4141
Practice Address - Fax:248-853-1641
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU70290Medicare UPIN