Provider Demographics
NPI:1891976262
Name:CAROLE L. HONG & KRISTINA STASKO, PTRS
Entity Type:Organization
Organization Name:CAROLE L. HONG & KRISTINA STASKO, PTRS
Other - Org Name:FAMILY VISION CARE AND VISION THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STASKO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-593-1661
Mailing Address - Street 1:1234 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3110
Mailing Address - Country:US
Mailing Address - Phone:650-593-1661
Mailing Address - Fax:650-595-5203
Practice Address - Street 1:1234 CHERRY ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3110
Practice Address - Country:US
Practice Address - Phone:650-593-1661
Practice Address - Fax:650-595-5203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8031T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ14015ZMedicare PIN