MEDICARE: SUSAN HARTLEY HORIUCHI 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	7484T	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	OP7484 CA	OTHER	CA	MEDICARE
5	0182880001	OTHER	CA	MEDICARE NSC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0180480001	OTHER	CA	CMS
4	0180480001	OTHER	CA	DMERC REGION D

General Provider Information

NPI Number	:	1881736320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN HARTLEY HORIUCHI OD

Provider Business Mailing Address
First Line	:	330 PARK AVE STE 4
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2352
Country	:	US
Telephone Number	:	949-494-2546
Fax Number	:	949-497-0010

Provider Business Practice Location Address
First Line	:	330 PARK AVE STE 4
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2352
Country	:	US
Telephone Number	:	949-494-2546
Fax Number	:	949-497-0010

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/03/2022

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Directions to “ SUSAN HARTLEY HORIUCHI OD” Practice Location

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