Individual provider Active NPI

Roger L. Wu, O.D.

  • Optometrist
  • West Covina, CA
National Provider Identifier
1063400604
Registry record updated Oct 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10971T Issued in CA
Practice address
2707 E Valley Blvd
Suite 216
West Covina, CA 91792-3195
Phone
(626) 810-3398
Fax
(626) 810-3342
NPI assigned
Oct 7, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 10971T CA Primary

Addresses

Primary practice location

2707 E Valley Blvd
Suite 216
West Covina, CA 91792-3195

Mailing address

2707 E Valley Blvd
Suite 216
West Covina, CA 91792-3195
Phone (626) 810-3398

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040413000952 CA Practitioner - Optometry 4688668544 Practice locations: West Covina, CA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2707 E Valley Blvd
Suite 216
West Covina, CA 91792-3197
Phone (626) 810-3398

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10971TCAMDOptometrist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445990400000",
    "number": "1063400604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2707 E VALLEY BLVD",
            "address_2": "SUITE 216",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917923195",
            "telephone_number": "626-810-3398",
            "fax_number": "626-810-3342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2707 E VALLEY BLVD",
            "address_2": "SUITE 216",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917923195",
            "telephone_number": "626-810-3398",
            "fax_number": "626-810-3342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WU",
        "first_name": "ROGER",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2015-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10971T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Covina, CA

Sources for this page

Verify at the official NPI Registry.