Provider Demographics
NPI:1114369709
Name:CANO, VINCENT (OD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:CANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25800 JERONIMO RD STE 701
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-7918
Mailing Address - Country:US
Mailing Address - Phone:559-859-8856
Mailing Address - Fax:
Practice Address - Street 1:25800 JERONIMO RD STE 701
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-7918
Practice Address - Country:US
Practice Address - Phone:559-859-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15363T152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy