Healthcare Provider Details

I. General information

NPI: 1144057829
Provider Name (Legal Business Name): DUYEN CAO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9460 MIRA MESA BLVD STE A
SAN DIEGO CA
92126-4870
US

IV. Provider business mailing address

PO BOX 23252
SAN DIEGO CA
92193-3252
US

V. Phone/Fax

Practice location:
  • Phone: 858-330-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT35838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: