Provider Demographics
NPI:1396153508
Name:CAO, JUDY (OD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:CAO
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 1:16816 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5702
Mailing Address - Country:US
Mailing Address - Phone:562-925-6591
Mailing Address - Fax:562-867-8719
Practice Address - Street 1:360 E LAS TUNAS DR STE 203
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-5514
Practice Address - Country:US
Practice Address - Phone:888-988-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15060TLG152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB262466OtherMEDICARE PTAN SO CAL