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General NPI Number Information
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NPI Number | 1316257504
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Entity Type | Organization
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Legal Business Name | TINA DAO OD INC
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 16027 BROOKHURST STREET SUITE E
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708
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Country | US
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Telephone | 714-210-2393
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Fax | 714-531-5507
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Provider Business Mailing Address
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Address Line | 16027 BROOKHURST STREET SUITE E
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708
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Country | US
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Telephone | 714-210-2393
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Fax | 714-531-5507
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TINA U. DAO
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Credential | O.D.
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Telephone | 714-210-2393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 11123T
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License Number State | CA
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