Provider Demographics
NPI:1013947902
Name:HUSSEY, ELAINE M (OD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:HUSSEY
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 1:2715 WILLETTA ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3471
Mailing Address - Country:US
Mailing Address - Phone:541-926-5848
Mailing Address - Fax:541-926-2873
Practice Address - Street 1:2715 WILLETTA ST SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3471
Practice Address - Country:US
Practice Address - Phone:541-926-5848
Practice Address - Fax:541-926-2873
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1542AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR116637Medicaid
ORT95414Medicare UPIN
OR410014157Medicare PIN
OR041WCKBCAMedicare ID - Type Unspecified
R041WCKBCAMedicare PIN
OR0648670001Medicare NSC