Healthcare Provider Details

I. General information

NPI: 1457416836
Provider Name (Legal Business Name): DAO OPTOMETRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31401 RANCHO VIEJO RD SUITE 103
SAN JUAN CAPISTRANO CA
92675
US

IV. Provider business mailing address

31401 RANCHO VIEJO RD SUITE 103
SAN JUAN CAPISTRANO CA
92675
US

V. Phone/Fax

Practice location:
  • Phone: 949-248-2590
  • Fax: 949-443-3828
Mailing address:
  • Phone: 949-248-2590
  • Fax: 949-443-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11275T
License Number StateCA

VIII. Authorized Official

Name: DR. STEVE DAO
Title or Position: PRESIDENT
Credential: O.D.
Phone: 949-248-2590