Provider Demographics
NPI:1659437465
Name:HSU, SAM (OD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:HSU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8070 160TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3810
Mailing Address - Country:US
Mailing Address - Phone:425-883-9300
Mailing Address - Fax:425-883-9649
Practice Address - Street 1:8070 160TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3810
Practice Address - Country:US
Practice Address - Phone:425-883-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003702152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA412056234OtherTAX ID NUMBER
WA412056234OtherTAX ID NUMBER