MEDICARE: TINA U. DAO O.D.

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	11123T	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5410440001	OTHER	CA	MEDICARE DMEPOS SUPPLIER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	459574002	OTHER	CA	CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770507659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA U. DAO O.D.

Provider Business Mailing Address
First Line	:	16027 BROOKHURST ST
Second Line	:	SUITE E
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-1551
Country	:	US
Telephone Number	:	714-210-2393
Fax Number	:

Provider Business Practice Location Address
First Line	:	16027 BROOKHURST ST
Second Line	:	SUITE E
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-1551
Country	:	US
Telephone Number	:	714-210-2393
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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