Provider Demographics
NPI:1831170463
Name:OH, SUSAN ANN (OD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:OH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2575 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1615
Mailing Address - Country:US
Mailing Address - Phone:714-449-7430
Mailing Address - Fax:714-992-7850
Practice Address - Street 1:1234 CHERRY ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3110
Practice Address - Country:US
Practice Address - Phone:650-593-1661
Practice Address - Fax:650-595-5203
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11935T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U93000Medicare UPIN
SD0119350Medicare ID - Type Unspecified