Provider Demographics
NPI:1801618103
Name:KWOK, CRISTALLE (OD)
Entity type:Individual
Prefix:DR
First Name:CRISTALLE
Middle Name:
Last Name:KWOK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5465 E. CANDLEWOOD CIR
Mailing Address - Street 2:UNIT B
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:650-995-3495
Mailing Address - Fax:
Practice Address - Street 1:17064 SLOVER AVENUE
Practice Address - Street 2:PALM COURT SUITE 104
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337
Practice Address - Country:US
Practice Address - Phone:909-258-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist