Provider Demographics
NPI:1790785780
Name:CUSHING, LINDA ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANNE
Last Name:CUSHING
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 1:1553 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:925-934-9383
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:925-934-9383
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9502T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ14176ZOtherPARTNERSHIP
CASD0095020Medicare ID - Type Unspecified
CAZZZ14176ZOtherPARTNERSHIP