Healthcare Provider Details

I. General information

NPI: 1790842920
Provider Name (Legal Business Name): LINH H DAO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9265 E BASELINE RD STE. 102
MESA AZ
85209-8312
US

IV. Provider business mailing address

9265 E BASELINE RD STE. 102
MESA AZ
85209-8312
US

V. Phone/Fax

Practice location:
  • Phone: 480-354-4030
  • Fax: 480-354-4492
Mailing address:
  • Phone: 480-354-4030
  • Fax: 480-354-4492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1133
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: