Healthcare Provider Details

I. General information

NPI: 1679762942
Provider Name (Legal Business Name): AMY K DAO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BALTIMORE PIKE
SPRINGFIELD PA
19064-2701
US

IV. Provider business mailing address

311 FAIRFIELD AVE
UPPER DARBY PA
19082-2208
US

V. Phone/Fax

Practice location:
  • Phone: 610-605-3192
  • Fax:
Mailing address:
  • Phone: 215-888-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT007231
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00612400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002047
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: