Provider Demographics
NPI:1316257504
Name:TINA DAO OD INC
Entity type:Organization
Organization Name:TINA DAO OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:U
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-210-2393
Mailing Address - Street 1:16027 BROOKHURST STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-210-2393
Mailing Address - Fax:714-531-5507
Practice Address - Street 1:16027 BROOKHURST STREET
Practice Address - Street 2:SUITE E
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-210-2393
Practice Address - Fax:714-531-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11123T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP11123Medicare PIN
U86891Medicare UPIN