MEDICARE: KENNETH DAO OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	011235	NY

General Provider Information

NPI Number	:	1659255883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH DAO OD

Provider Business Mailing Address
First Line	:	15 3RD CT
Second Line	:
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-3025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1958-1962 MIDDLE COUNTRY RD
Second Line	:
City	:	CENTEREACH
State	:	NY
Zip	:	11720-3535
Country	:	US
Telephone Number	:	631-467-0524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/01/2025

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