Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 7970T | CA |
NPI | 1013059260 |
---|---|
Provider Name | Dr. Richard Wayne Jue |
First Address | Oakland, CA 94611-2815 |
Second Address | Oakland, CA 94611-2815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7970T | OPTOMETRIC LICENSE (01) | CA |
MJ1311810 | DEA NUMBER (01) | CA |
U06521 | (02) | CA |