Healthcare Provider Details

I. General information

NPI: 1104896513
Provider Name (Legal Business Name): SOPHIE K DAO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 MONTAGUE EXPY STE 111
MILPITAS CA
95035-6818
US

IV. Provider business mailing address

991 MONTAGUE EXPY STE 111
MILPITAS CA
95035-6809
US

V. Phone/Fax

Practice location:
  • Phone: 408-262-1221
  • Fax: 408-262-0789
Mailing address:
  • Phone: 408-262-1221
  • Fax: 408-262-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8213T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number8213T
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number8213T
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number8213T
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number8213T
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number8213T
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number8213T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: