Provider Demographics
NPI:1457646234
Name:ALICE KWOK, O.D., PLLC
Entity Type:Organization
Organization Name:ALICE KWOK, O.D., PLLC
Other - Org Name:OHANA EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KWOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-583-8388
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z147100OtherMEDICARE PTAN