Provider Demographics
NPI:1538349196
Name:TOM, DANITA (MD)
Entity type:Individual
Prefix:DR
First Name:DANITA
Middle Name:
Last Name:TOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:101 THE CITY DR S
Mailing Address - Street 2:DEPT OF OPHTHALMOLOGY
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3201
Mailing Address - Country:US
Mailing Address - Phone:949-824-0158
Mailing Address - Fax:949-824-4015
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:DEPT OF OPHTHALMOLOGY
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:949-824-0158
Practice Address - Fax:949-824-4015
Is Sole Proprietor?:No
Enumeration Date:2007-11-11
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA99289207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology