Provider Demographics
NPI:1023026101
Name:DAO, DIANNE (OD)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:DAO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 NANTUCKET CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2705 BROADWAY ST
Practice Address - Street 2:SUITE 115
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4902
Practice Address - Country:US
Practice Address - Phone:281-485-2020
Practice Address - Fax:281-485-1386
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5647T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162135101Medicaid
TX00473EMedicare ID - Type Unspecified
TXU74473Medicare UPIN