MEDICARE: DR. CONNIE HA O.D.

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	11141	CA

General Provider Information

NPI Number	:	1700807369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONNIE HA O.D.

Provider Business Mailing Address
First Line	:	931 SAN BRUNO AVE W RM 4
Second Line	:
City	:	SAN BRUNO
State	:	CA
Zip	:	94066-3435
Country	:	US
Telephone Number	:	650-588-7701
Fax Number	:	650-588-7797

Provider Business Practice Location Address
First Line	:	931 SAN BRUNO AVE W RM 4
Second Line	:
City	:	SAN BRUNO
State	:	CA
Zip	:	94066-3435
Country	:	US
Telephone Number	:	650-588-7701
Fax Number	:	650-588-7797

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/25/2013

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Directions to “ DR. CONNIE HA O.D.” Practice Location

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