Provider Demographics
NPI:1730557182
Name:MAI, AMY LUU QA (OD)
Entity type:Individual
Prefix:
First Name:AMY LUU
Middle Name:QA
Last Name:MAI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:Q
Other - Last Name:LUU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5488 S. PADRE ISLAND DRIVE
Mailing Address - Street 2:SUITE 2042
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411
Mailing Address - Country:US
Mailing Address - Phone:361-994-0310
Mailing Address - Fax:361-994-0452
Practice Address - Street 1:5488 S. PADRE ISLAND DRIVE
Practice Address - Street 2:SUITE 2042
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-994-0310
Practice Address - Fax:361-994-0452
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8780T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist