Healthcare Provider Details

I. General information

NPI: 1689125502
Provider Name (Legal Business Name): KRISTIN UCHIZONO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16450 BOLSA CHICA ST
HUNTINGTON BEACH CA
92649-2603
US

IV. Provider business mailing address

18151 PALMETTO CIR
FOUNTAIN VALLEY CA
92708-5752
US

V. Phone/Fax

Practice location:
  • Phone: 714-840-1366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: