Healthcare Provider Details

I. General information

NPI: 1659255883
Provider Name (Legal Business Name): KENNETH DAO OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1958-1962 MIDDLE COUNTRY RD
CENTEREACH NY
11720-3535
US

IV. Provider business mailing address

15 3RD CT
RONKONKOMA NY
11779-3025
US

V. Phone/Fax

Practice location:
  • Phone: 631-467-0524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011235
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: