Provider Demographics
NPI:1063031094
Name:HUSSERL, CONNIE (OD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HUSSERL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:8467 DEERVALE RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1021
Mailing Address - Country:US
Mailing Address - Phone:805-268-4743
Mailing Address - Fax:
Practice Address - Street 1:2709 STONERIDGE DR STE 112
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8358
Practice Address - Country:US
Practice Address - Phone:925-462-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist