Provider Demographics
NPI:1588936942
Name:DAO, CHARLIE C (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:C
Last Name:DAO
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 1:2405 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-6206
Mailing Address - Country:US
Mailing Address - Phone:620-227-2471
Mailing Address - Fax:
Practice Address - Street 1:2405 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-6206
Practice Address - Country:US
Practice Address - Phone:620-227-2471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7890152W00000X
KS2070152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist