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Individual

CHARLES E DOMINGUEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
21098 BAKE PKWY, SUITE 110, LAKE FOREST, CA 92630-2163
(949) 597-0104
Mailing address
21098 BAKE PKWY, SUITE 110, LAKE FOREST, CA 92630-2163
(949) 597-0104

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT 12292 TPA
CA

Other

Enumeration date
07/13/2006
Last updated
10/15/2014
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