Healthcare Provider Details

I. General information

NPI: 1588711519
Provider Name (Legal Business Name): GRACE E KUO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 DEL AMO FASHION SQ
TORRANCE CA
90503-5713
US

IV. Provider business mailing address

22731 DRAILLE DR
TORRANCE CA
90505-3368
US

V. Phone/Fax

Practice location:
  • Phone: 310-371-5761
  • Fax:
Mailing address:
  • Phone: 310-543-2465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: