MEDICARE: SUSAN PI-SHIAN HSU OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	8365TPA	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BG279Z	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1164403556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN PI-SHIAN HSU OD

Provider Business Mailing Address
First Line	:	2014 PALMETTO AVE
Second Line	:	STE B
City	:	PACIFICA
State	:	CA
Zip	:	94044-2796
Country	:	US
Telephone Number	:	650-359-2231
Fax Number	:	650-359-2305

Provider Business Practice Location Address
First Line	:	2014 PALMETTO AVE
Second Line	:	STE B
City	:	PACIFICA
State	:	CA
Zip	:	94044-2796
Country	:	US
Telephone Number	:	650-359-2231
Fax Number	:	650-359-2305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	06/09/2010

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Directions to “ SUSAN PI-SHIAN HSU OD” Practice Location

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