Healthcare Provider Details

I. General information

NPI: 1215660436
Provider Name (Legal Business Name): STEPHANIE CAO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 GROSSMONT CENTER DR STE 215
LA MESA CA
91942-3091
US

IV. Provider business mailing address

5500 GROSSMONT CENTER DR STE 215
LA MESA CA
91942-3091
US

V. Phone/Fax

Practice location:
  • Phone: 619-469-0131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: