Healthcare Provider Details

I. General information

NPI: 1467643486
Provider Name (Legal Business Name): TIFFANY C HSUEH O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 NEWPARK MALL
NEWARK CA
94560-5246
US

IV. Provider business mailing address

713 EUCLID AVE
BERKELEY CA
94708-1333
US

V. Phone/Fax

Practice location:
  • Phone: 510-792-6775
  • Fax:
Mailing address:
  • Phone: 510-375-6706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: