Organization
DOMINGUEZ ALDERSON OPTOMETRIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES E DOMINGUEZ OD (MEDICAL DIRECTOR)
(949) 597-0104
Entity
Organization
Contact information
Practice address
21098 BAKE PKWY, SUITE 110, LAKE FOREST, CA 92630-2163
(949) 597-0104
(949) 597-0106
Mailing address
21098 BAKE PKWY, SUITE 110, LAKE FOREST, CA 92630-2163
(949) 597-0104
(949) 597-0106
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
04/26/2011
Last updated
10/15/2014
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