Healthcare Provider Details

I. General information

NPI: 1376837310
Provider Name (Legal Business Name): ASHLEY DANIELLE DEEMER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 E LA PALMA AVE
ANAHEIM CA
92807-2023
US

IV. Provider business mailing address

5460 E LA PALMA AVE
ANAHEIM CA
92807-2023
US

V. Phone/Fax

Practice location:
  • Phone: 714-463-7500
  • Fax: 714-992-7850
Mailing address:
  • Phone: 714-463-7500
  • Fax: 714-992-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberTA2456
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: