Provider Demographics
NPI:1093171225
Name:MICHAEL G. KWOK, O.D. PLLC
Entity Type:Organization
Organization Name:MICHAEL G. KWOK, O.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:KWOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:443-845-1188
Mailing Address - Street 1:8123 GILROY DR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2937
Mailing Address - Country:US
Mailing Address - Phone:443-845-1188
Mailing Address - Fax:
Practice Address - Street 1:440 SPOTSYLVANIA TOWNE CENTRE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-1123
Practice Address - Country:US
Practice Address - Phone:540-786-2272
Practice Address - Fax:540-786-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty