Provider Demographics
NPI:1245387315
Name:HAMEL, SUSAN HSU (OD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HSU
Last Name:HAMEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:HSU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:P.O. BOX 186
Mailing Address - Street 2:1901 MITCHELL ROAD STE. C.
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2400
Mailing Address - Country:US
Mailing Address - Phone:209-537-8971
Mailing Address - Fax:209-537-8974
Practice Address - Street 1:1901 MITCHELL RD STE C
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2400
Practice Address - Country:US
Practice Address - Phone:209-537-8971
Practice Address - Fax:209-537-8974
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12462T152W00000X
CAOPT12462TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV04842Medicare UPIN