Healthcare Provider Details

I. General information

NPI: 1396656526
Provider Name (Legal Business Name): STEPHANIE CAO, O.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/15/2026
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: 619-469-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE CAO
Title or Position: PRESIDENT
Credential: OD
Phone: 619-469-0131