Provider Demographics
NPI:1811997828
Name:ENG, KRISTINE M (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:M
Last Name:ENG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:20 ORINDA WAY
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2519
Mailing Address - Country:US
Mailing Address - Phone:925-253-1320
Mailing Address - Fax:925-253-1939
Practice Address - Street 1:20 ORINDA WAY
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2519
Practice Address - Country:US
Practice Address - Phone:925-253-1320
Practice Address - Fax:925-253-1939
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12019T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00708150OtherGROUP MEMBER PTAN
CA1487843652OtherGROUP NPI
CADO8075OtherGROUP PTAN
CASD0120191Medicare PIN
CAP00708150OtherGROUP MEMBER PTAN