Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 18004063 | IN |
N | 152W00000X | Optometrist | 18004063A | IN |
N | 152W00000X | Optometrist | 2018034549 | MO |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2018034549 | MO |
NPI | 1255867149 |
---|---|
Provider Name | Dr. Jessica Tu |
First Address | St. Louis, MO 63121 |
Second Address | St. Louis, MO 63121-4617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 10/06/2020 |