Healthcare Provider Details

I. General information

NPI: 1104675735
Provider Name (Legal Business Name): SAMANTHA DAOUD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2673 VIA DE LA VALLE STE F
DEL MAR CA
92014-1912
US

IV. Provider business mailing address

3691 VIA MERCADO STE 11
LA MESA CA
91941-8327
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-9465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: