Healthcare Provider Details

I. General information

NPI: 1679615348
Provider Name (Legal Business Name): OWEN Y HSU OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11260 WHITE ROCK ROAD
RANCHO CORDOVA CA
95742
US

IV. Provider business mailing address

1649 PARKWAY DRIVE
FOLSOM CA
95630
US

V. Phone/Fax

Practice location:
  • Phone: 916-638-7276
  • Fax: 916-638-7290
Mailing address:
  • Phone: 916-984-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: