Provider Demographics
NPI:1467643486
Name:HSUEH, TIFFANY C (OD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:C
Last Name:HSUEH
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 1:713 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1333
Mailing Address - Country:US
Mailing Address - Phone:510-375-6706
Mailing Address - Fax:
Practice Address - Street 1:1115 NEWPARK MALL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5246
Practice Address - Country:US
Practice Address - Phone:510-792-6775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13264152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist