Provider Demographics
NPI:1396576955
Name:DOMINGO, ARMAND NESTOR (OD)
Entity type:Individual
Prefix:
First Name:ARMAND
Middle Name:NESTOR
Last Name:DOMINGO
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 1:2726 ANNAPOLIS CIR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4108
Mailing Address - Country:US
Mailing Address - Phone:909-855-3038
Mailing Address - Fax:
Practice Address - Street 1:30080 HAUN RD SPC 2
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-6817
Practice Address - Country:US
Practice Address - Phone:951-301-4248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT35814-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist