Provider Demographics
NPI:1750409488
Name:KURT R SKINNER & LINDA W T HSU OD
Entity type:Organization
Organization Name:KURT R SKINNER & LINDA W T HSU OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:209-957-5122
Mailing Address - Street 1:3133 W MARCH LN STE 2020
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2361
Mailing Address - Country:US
Mailing Address - Phone:209-957-5122
Mailing Address - Fax:209-951-2348
Practice Address - Street 1:3133 W MARCH LN STE 2020
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2361
Practice Address - Country:US
Practice Address - Phone:209-957-5122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124086269OtherNPI
CA1386601292OtherNPI
CASD0089180Medicaid
CA1750409488OtherGRP NPI
CASD0088610Medicaid
CA1750409488OtherGRP NPI
CASD0089180Medicaid
CA1124086269OtherNPI