Provider Demographics
NPI:1154043982
Name:HU, JESSICA (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:HU
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 N WATERMAN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4842
Mailing Address - Country:US
Mailing Address - Phone:909-882-8883
Mailing Address - Fax:
Practice Address - Street 1:180 W GIRARD AVE STE 5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1660
Practice Address - Country:US
Practice Address - Phone:215-554-6222
Practice Address - Fax:215-554-6200
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35252152W00000X
PAOEG004220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist