Healthcare Provider Details

I. General information

NPI: 1114041746
Provider Name (Legal Business Name): ALLISON HONGDIEP CAO-LE O D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 12/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 ALVARADO ST
MONTEREY CA
93940-2717
US

IV. Provider business mailing address

454 ALVARADO ST
MONTEREY CA
93940-2717
US

V. Phone/Fax

Practice location:
  • Phone: 831-372-9100
  • Fax:
Mailing address:
  • Phone: 831-372-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number11808T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: