Healthcare Provider Details

I. General information

NPI: 1790785251
Provider Name (Legal Business Name): MICHAEL A HSU O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 35TH AVE NE STE 4
SEATTLE WA
98115-7344
US

IV. Provider business mailing address

6850 35TH AVE NE STE 4
SEATTLE WA
98115-7344
US

V. Phone/Fax

Practice location:
  • Phone: 206-527-1900
  • Fax: 206-374-2550
Mailing address:
  • Phone: 206-527-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00001292
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: