Provider Demographics
NPI:1902302573
Name:CHEUNG, KRISTI MICHELE (OD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:MICHELE
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:MICHELE
Other - Last Name:LEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3801 MIRANDA AVE
Mailing Address - Street 2:BUILDING 5, 1ST FLOOR OPTOMETRY, OPTOM 112
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-3672
Mailing Address - Country:US
Mailing Address - Phone:626-251-3103
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE BLDG 5
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34061152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist