Provider Demographics
NPI:1063542439
Name:DACANAY, GRACE JAVIER (OD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:JAVIER
Last Name:DACANAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:RIVERA
Other - Last Name:JAVIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:19430 PILARIO ST
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3143
Mailing Address - Country:US
Mailing Address - Phone:310-913-3447
Mailing Address - Fax:
Practice Address - Street 1:15909 MAIN ST
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-4720
Practice Address - Country:US
Practice Address - Phone:626-961-0876
Practice Address - Fax:626-336-0142
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12589T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist