Provider Demographics
NPI:1922148634
Name:VO, KRISTIE ANH (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:ANH
Last Name:VO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6445 PATS RANCH RD STE D
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-4439
Mailing Address - Country:US
Mailing Address - Phone:951-371-3937
Mailing Address - Fax:951-371-6735
Practice Address - Street 1:6445 PATS RANCH RD STE D
Practice Address - Street 2:
Practice Address - City:MIRA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91752-4439
Practice Address - Country:US
Practice Address - Phone:951-371-3937
Practice Address - Fax:951-371-6735
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11402T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922148634Medicaid
CA1235309667Medicaid