Healthcare Provider Details

I. General information

NPI: 1689932840
Provider Name (Legal Business Name): HACIENDA PARK OPTOMETRY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 HOPYARD RD STE F1
PLEASANTON CA
94588-2772
US

IV. Provider business mailing address

4825 HOPYARD RD STE F1
PLEASANTON CA
94588-2772
US

V. Phone/Fax

Practice location:
  • Phone: 925-227-0400
  • Fax: 925-227-0730
Mailing address:
  • Phone: 925-227-0400
  • Fax: 925-227-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9502T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9246T
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA ANNE CUSHING
Title or Position: PRESIDENT
Credential: O.D.
Phone: 925-227-0400