Healthcare Provider Details

I. General information

NPI: 1801618103
Provider Name (Legal Business Name): CRISTALLE KWOK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 CANYON SPRINGS PKWY STE 103
RIVERSIDE CA
92507-0942
US

IV. Provider business mailing address

13482 MISTY MEADOW CT
CHINO HILLS CA
91709-1224
US

V. Phone/Fax

Practice location:
  • Phone: 951-583-1820
  • Fax: 951-618-7116
Mailing address:
  • Phone: 650-995-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: