Provider Demographics
NPI:1770507659
Name:DAO, TINA U (OD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:U
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 1:16027 BROOKHURST ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1551
Mailing Address - Country:US
Mailing Address - Phone:714-210-2393
Mailing Address - Fax:
Practice Address - Street 1:16027 BROOKHURST ST
Practice Address - Street 2:SUITE E
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1551
Practice Address - Country:US
Practice Address - Phone:714-210-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11123T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5410440001OtherMEDICARE DMEPOS SUPPLIER
CA459574002OtherCIGNA
CASD0111230Medicaid
CAU86891Medicare UPIN
CAOP11123Medicare ID - Type Unspecified