Healthcare Provider Details

I. General information

NPI: 1750277463
Provider Name (Legal Business Name): JENNETTA DAO OD
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: JENNETTA MINH-THO DAO OD

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 08/20/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 MEMORIAL DR
WACO TX
76711-1329
US

IV. Provider business mailing address

4800 MEMORIAL DR
WACO TX
76711-1329
US

V. Phone/Fax

Practice location:
  • Phone: 254-297-3000
  • Fax:
Mailing address:
  • Phone: 254-297-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11472
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: