Provider Demographics
NPI:1578963682
Name:DAO, MAVIS (OD)
Entity Type:Individual
Prefix:
First Name:MAVIS
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 1:3206 E CEDAR HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8125
Mailing Address - Country:US
Mailing Address - Phone:832-606-5761
Mailing Address - Fax:
Practice Address - Street 1:10961 NORTH FWY STE 102A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1139
Practice Address - Country:US
Practice Address - Phone:281-445-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00656100152W00000X
TX8473TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist