Provider Demographics
NPI:1457416836
Name:DAO OPTOMETRIC GROUP
Entity Type:Organization
Organization Name:DAO OPTOMETRIC GROUP
Other - Org Name:SAN JUAN OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-248-2590
Mailing Address - Street 1:31401 RANCHO VIEJO RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675
Mailing Address - Country:US
Mailing Address - Phone:949-248-2590
Mailing Address - Fax:949-443-3828
Practice Address - Street 1:31401 RANCHO VIEJO RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675
Practice Address - Country:US
Practice Address - Phone:949-248-2590
Practice Address - Fax:949-443-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11275T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGD783AMedicare PIN