Healthcare Provider Details

I. General information

NPI: 1245387315
Provider Name (Legal Business Name): SUSAN HSU HAMEL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN HSU O.D.

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MITCHELL RD STE C
CERES CA
95307-2400
US

IV. Provider business mailing address

P.O. BOX 186 1901 MITCHELL ROAD STE. C.
CERES CA
95307-2400
US

V. Phone/Fax

Practice location:
  • Phone: 209-537-8971
  • Fax: 209-537-8974
Mailing address:
  • Phone: 209-537-8971
  • Fax: 209-537-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12462T
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT12462TPL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: