Provider Demographics
NPI:1962463604
Name:KWONG, CARL (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:KWONG
Suffix:
Gender:M
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:PO BOX 31903
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-0903
Mailing Address - Country:US
Mailing Address - Phone:415-823-1199
Mailing Address - Fax:408-923-3303
Practice Address - Street 1:1937-A TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122
Practice Address - Country:US
Practice Address - Phone:408-923-0400
Practice Address - Fax:408-923-3303
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8769T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
533381OtherOE
CASD0087690Medicaid
SD0087690Medicare ID - Type Unspecified
533381OtherOE