Provider Demographics
NPI:1417014119
Name:KWOK, ALICE (OD)
Entity Type:Individual
Prefix:
First Name:ALICE
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 1:8671 W UNION HILLS DR
Mailing Address - Street 2:STE 502
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7005
Mailing Address - Country:US
Mailing Address - Phone:623-583-8388
Mailing Address - Fax:623-972-3225
Practice Address - Street 1:8671 W UNION HILLS DR
Practice Address - Street 2:STE 502
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7005
Practice Address - Country:US
Practice Address - Phone:623-583-8388
Practice Address - Fax:623-972-3225
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ635656Medicaid
Z147101OtherMEDICARE PTAN