Provider Demographics
NPI:1386792034
Name:HLUSAK, MARTIN G (OD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:G
Last Name:HLUSAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:914 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4407
Mailing Address - Country:US
Mailing Address - Phone:530-257-2225
Mailing Address - Fax:530-257-2225
Practice Address - Street 1:914 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4407
Practice Address - Country:US
Practice Address - Phone:530-257-2225
Practice Address - Fax:530-257-2225
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA6047T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist