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NPI Code Detail

MEDICARE: SUSAN ANN OH OD

MEDICARE: SUSAN ANN OH 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
1152W00000XOptometrist11935TCA

General Provider Information

NPI Number : 1831170463
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN ANN OH OD
Provider Business Mailing Address
First Line : 2575 YORBA LINDA BLVD
Second Line :
City : FULLERTON
State : CA
Zip : 92831-1615
Country : US
Telephone Number : 714-449-7430
Fax Number : 714-992-7850
Provider Business Practice Location Address
First Line : 1234 CHERRY ST
Second Line :
City : SAN CARLOS
State : CA
Zip : 94070-3110
Country : US
Telephone Number : 650-593-1661
Fax Number : 650-595-5203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 10/26/2015

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Directions to “ SUSAN ANN OH OD” Practice Location

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