Provider Demographics
NPI:1962761106
Name:TERESA J LUI OD INC
Entity type:Organization
Organization Name:TERESA J LUI OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:LUI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-321-9525
Mailing Address - Street 1:616 RAMONA ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2577
Mailing Address - Country:US
Mailing Address - Phone:650-321-9525
Mailing Address - Fax:866-805-6069
Practice Address - Street 1:616 RAMONA ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2577
Practice Address - Country:US
Practice Address - Phone:650-321-9525
Practice Address - Fax:866-805-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0077220OtherPTAN
CASD0077220OtherPTAN