Healthcare Provider Details

I. General information

NPI: 1528518032
Provider Name (Legal Business Name): THU HUA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WASHINGTON RD
WEST POINT NY
10996-1109
US

IV. Provider business mailing address

2335 RAVINE DR
SAN JOSE CA
95133-1256
US

V. Phone/Fax

Practice location:
  • Phone: 315-774-8510
  • Fax: 315-774-8906
Mailing address:
  • Phone: 408-772-0114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: