Healthcare Provider Details

I. General information

NPI: 1851790893
Provider Name (Legal Business Name): GRACE WEIYOWN HSU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 N EUCLID ST
ANAHEIM CA
92801-4622
US

IV. Provider business mailing address

661 N EUCLID ST
ANAHEIM CA
92801-4622
US

V. Phone/Fax

Practice location:
  • Phone: 714-817-0606
  • Fax: 714-817-0612
Mailing address:
  • Phone: 714-817-0606
  • Fax: 714-817-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number15097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: