Provider Demographics
NPI:1235309667
Name:KRISTIE VO O.D, INC
Entity Type:Organization
Organization Name:KRISTIE VO O.D, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-334-5237
Mailing Address - Street 1:27867 CRESCENT CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5738
Mailing Address - Country:US
Mailing Address - Phone:714-334-5237
Mailing Address - Fax:909-355-8500
Practice Address - Street 1:6445 PATS RANCH RD
Practice Address - Street 2:SUITE D
Practice Address - City:MIRA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91752-4439
Practice Address - Country:US
Practice Address - Phone:714-334-5237
Practice Address - Fax:909-355-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11402T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty