Provider Demographics
NPI:1558568568
Name:LINDA ANNE CUSHING OD & CHESLYN MEI GAN OD
Entity Type:Organization
Organization Name:LINDA ANNE CUSHING OD & CHESLYN MEI GAN OD
Other - Org Name:CUSHING AND GAN OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESLYN
Authorized Official - Middle Name:MEI
Authorized Official - Last Name:GAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-934-9328
Mailing Address - Street 1:1553 PALOS VERDES MALL
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2228
Mailing Address - Country:US
Mailing Address - Phone:925-934-9328
Mailing Address - Fax:
Practice Address - Street 1:1553 PALOS VERDES MALL
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2228
Practice Address - Country:US
Practice Address - Phone:925-934-9328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ14176ZMedicare ID - Type Unspecified