Healthcare Provider Details

I. General information

NPI: 1730072802
Provider Name (Legal Business Name): DALLIN JAYSON DHUART OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4976 VERDUGO WAY
CAMARILLO CA
93012-8632
US

IV. Provider business mailing address

4976 VERDUGO WAY
CAMARILLO CA
93012-8632
US

V. Phone/Fax

Practice location:
  • Phone: 805-482-4628
  • Fax: 805-482-4628
Mailing address:
  • Phone: 805-616-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: