MEDICARE: DR. CHARLIE C DAO OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7890	TX
2	152W00000X	Optometrist	2070	KS

General Provider Information

NPI Number	:	1588936942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLIE C DAO OD

Provider Business Mailing Address
First Line	:	2405 CENTRAL AVE
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-6206
Country	:	US
Telephone Number	:	620-227-2471
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 CENTRAL AVE
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-6206
Country	:	US
Telephone Number	:	620-227-2471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2012
Last Update Date	:	03/07/2022

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