Individual provider Active NPI

Tiffany Yi-Tin Lu, O. D.

  • Optometrist
  • Sacramento, CA
National Provider Identifier
1710122312
Registry record updated Jul 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13388T Issued in CA
Practice address
2409 15TH St
Sacramento, CA 95818-2238
Phone
(916) 443-8034
NPI assigned
Dec 10, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 13388T CA Primary

Addresses

Primary practice location

2409 15TH St
Sacramento, CA 95818-2238

Mailing address

2409 15TH St
Sacramento, CA 95818-2238
Phone (916) 443-8034

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
13388TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Jessica Huynh OD PC Optometrist CurrentSince Jul 7, 2024 Accepting new patients
Nichole R. Moos, O.D. Inc Optometrist Past Accepting new patients
Kubo & Kubo, O.D.S Optometrist PastSince Jul 7, 2024 Accepting new patients

Locations

2409 15th St
Sacramento, CA 95818
Phone (916) 335-9655

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1228867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1710122312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2409 15TH ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958182238",
            "telephone_number": "916-443-8034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2409 15TH ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958182238",
            "telephone_number": "916-443-8034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LU",
        "first_name": "TIFFANY",
        "middle_name": "YI-TIN",
        "name_prefix": "Dr.",
        "credential": "O. D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-10",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13388T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.