MEDICARE: DR. SUI XIN SITU 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	14120	CA

General Provider Information

NPI Number	:	1770872699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUI XIN SITU O.D.

Provider Business Mailing Address
First Line	:	2645 OCEAN AVE STE 1A
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94132-1623
Country	:	US
Telephone Number	:	415-334-6688
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 OCEAN AVE STE 1A
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94132-1623
Country	:	US
Telephone Number	:	415-334-6688
Fax Number	:

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

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	01/03/2022

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