Provider Demographics
NPI:1538210182
Name:LUM, STEPHEN W (OD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:LUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 FLANDERS DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2825
Mailing Address - Country:US
Mailing Address - Phone:619-655-0313
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-477-9621
Practice Address - Fax:619-477-9717
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12485T152W00000X
WAOD60276564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP12485EMedicare ID - Type Unspecified
CAU98005Medicare UPIN