Healthcare Provider Details

I. General information

NPI: 1023026101
Provider Name (Legal Business Name): DIANNE DAO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 BROADWAY ST SUITE 115
PEARLAND TX
77581-4902
US

IV. Provider business mailing address

3106 NANTUCKET CT
PEARLAND TX
77584-7983
US

V. Phone/Fax

Practice location:
  • Phone: 281-485-2020
  • Fax: 281-485-1386
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5647T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: