Provider Demographics
NPI:1871143883
Name:DIAL, AILLEEN JACOB (OD)
Entity type:Individual
Prefix:DR
First Name:AILLEEN
Middle Name:JACOB
Last Name:DIAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AILLEEN
Other - Middle Name:DEOCADIZ
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 ENTERPRISE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2626
Mailing Address - Country:US
Mailing Address - Phone:949-688-6205
Mailing Address - Fax:
Practice Address - Street 1:1360 EASTLAKE PKWY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-4116
Practice Address - Country:US
Practice Address - Phone:619-482-1603
Practice Address - Fax:619-566-4117
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34384TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist