Individual
IDY S WU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1657 BATH AVE, BROOKLYN, NY 11214-4509
(718) 331-1491
Mailing address
1657 BATH AVE, BROOKLYN, NY 11214-4509
(718) 331-1491
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV006988
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A400005752
MEDICARE PTAN
NY
Enumeration date
10/27/2006
Last updated
04/19/2025
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