Provider Demographics
NPI:1942361712
Name:LINK, SUSAN H (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
Last Name:LINK
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 1:491 30TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-444-0603
Mailing Address - Fax:510-444-6046
Practice Address - Street 1:491 30TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-444-0603
Practice Address - Fax:510-444-6046
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9734152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0097340Medicaid
442342Medicare UPIN
CA570097340Medicare ID - Type Unspecified