MEDICARE: JUSTIN HU, O.D., INCORPORATED

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	13761 TLG	CA

General Provider Information

NPI Number	:	1508148941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUSTIN HU, O.D., INCORPORATED

Provider Business Mailing Address
First Line	:	1103 FAIR OAKS AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3311
Country	:	US
Telephone Number	:	626-441-0770
Fax Number	:	626-441-0990

Provider Business Practice Location Address
First Line	:	1103 FAIR OAKS AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3311
Country	:	US
Telephone Number	:	626-441-0770
Fax Number	:	626-441-0990

Authorized Official
Title or Position	:	OWNER, OPTOMETRIST
Name	:	DR. JUSTIN HU
Credential	:	O.D.
Telephone Number	:	626-441-0770

Provider Enumeration Date	:	09/12/2011
Last Update Date	:	09/12/2011

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