Individual
JENNY XU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1221 S CREASY LN STE A, LAFAYETTE, IN 47905-7430
(165) 447-4951
Mailing address
1063 MANGROVE LN, ALAMEDA, CA 94502-7009
(909) 576-7710
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18004349A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/08/2012
Last updated
08/26/2022
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