Provider Demographics
NPI:1124086269
Name:HSU, LINDA (OD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HSU
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 1:3133 W MARCH LN
Mailing Address - Street 2:SUITE 2020
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3133 W MARCH LN
Practice Address - Street 2:SUITE 2020
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2336
Practice Address - Country:US
Practice Address - Phone:209-957-5122
Practice Address - Fax:209-951-2348
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8918T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0694800001OtherDMERC
CASD0089180Medicaid
CABU672ZMedicare PIN
CABU672WMedicare PIN
CABU672VMedicare PIN
CASD0089180Medicaid
CABU672XMedicare PIN
CA0694800001OtherDMERC
CABU672YMedicare PIN
CASD0089180Medicare PIN