Provider Demographics
NPI:1144906462
Name:WU, RICHARD I (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:I
Last Name:WU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:I TSUNG
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1167 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2586
Mailing Address - Country:US
Mailing Address - Phone:415-200-7219
Mailing Address - Fax:
Practice Address - Street 1:7129 NE IMBRIE DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7594
Practice Address - Country:US
Practice Address - Phone:503-690-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2595T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist