Healthcare Provider Details

I. General information

NPI: 1346269271
Provider Name (Legal Business Name): UYEN DAO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 RESEARCH WAY
EAST SETAUKET NY
11733
US

IV. Provider business mailing address

P.O. BOX 1559
STONY BROOK NY
11790
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number006851
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: