Provider Demographics
NPI:1114050929
Name:HSU, TERESA I-HUA (OD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:I-HUA
Last Name:HSU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 RIVERSIDE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5937
Mailing Address - Country:US
Mailing Address - Phone:770-804-1684
Mailing Address - Fax:770-804-1679
Practice Address - Street 1:800 MOUNT VERNON HWY NE
Practice Address - Street 2:SUITE 130
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4295
Practice Address - Country:US
Practice Address - Phone:770-804-1684
Practice Address - Fax:770-804-1679
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002240152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002240OtherGEORGIA LICENSE NUMBER
GA002240OtherGEORGIA LICENSE NUMBER