Provider Demographics
NPI:1689932840
Name:HACIENDA PARK OPTOMETRY, INC
Entity Type:Organization
Organization Name:HACIENDA PARK OPTOMETRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-227-0400
Mailing Address - Street 1:4825 HOPYARD RD STE F1
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2772
Mailing Address - Country:US
Mailing Address - Phone:925-227-0400
Mailing Address - Fax:925-227-0730
Practice Address - Street 1:4825 HOPYARD RD STE F1
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2772
Practice Address - Country:US
Practice Address - Phone:925-227-0400
Practice Address - Fax:925-227-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9502T152W00000X
CA9246T152W00000X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty