Healthcare Provider Details

I. General information

NPI: 1043699382
Provider Name (Legal Business Name): STACY NINA HU O.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10837 LAUREL ST STE 202
RANCHO CUCAMONGA CA
91730-7669
US

IV. Provider business mailing address

10837 LAUREL ST STE 202
RANCHO CUCAMONGA CA
91730-7669
US

V. Phone/Fax

Practice location:
  • Phone: 909-987-3330
  • Fax: 909-706-3773
Mailing address:
  • Phone: 909-987-3330
  • Fax: 909-706-3773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33494
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number60559136
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: