1548394778 NPI number — DR. DARYL ANTHONY DOI O.D.

Table of content: DR. DARYL ANTHONY DOI O.D. (NPI 1548394778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548394778 NPI number — DR. DARYL ANTHONY DOI O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOI
Provider First Name:
DARYL
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548394778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 737
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOAQUIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93660-0737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-846-5252
Provider Business Mailing Address Fax Number:
559-846-5511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
942 S. MADERA AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERMAN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-364-2980
Provider Business Practice Location Address Fax Number:
559-846-9157
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  9233T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FHC053875F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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