Provider Demographics
NPI:1710122312
Name:LU, TIFFANY YI-TIN (O D)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:YI-TIN
Last Name:LU
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 15TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-2238
Mailing Address - Country:US
Mailing Address - Phone:916-443-8034
Mailing Address - Fax:
Practice Address - Street 1:2409 15TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-2238
Practice Address - Country:US
Practice Address - Phone:916-443-8034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13388T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist