Provider Demographics
NPI:1902254147
Name:MOSAIC EYE SPECIALISTS, PC
Entity Type:Organization
Organization Name:MOSAIC EYE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-226-1877
Mailing Address - Street 1:3555 ROSECRANS ST STE 107B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3232
Mailing Address - Country:US
Mailing Address - Phone:619-226-1877
Mailing Address - Fax:619-226-0482
Practice Address - Street 1:3555 ROSECRANS ST STE 107B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3232
Practice Address - Country:US
Practice Address - Phone:619-226-1877
Practice Address - Fax:619-226-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA136640207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770870446Medicaid