Healthcare Provider Details

I. General information

NPI: 1093171225
Provider Name (Legal Business Name): MICHAEL G. KWOK, O.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SPOTSYLVANIA TOWNE CENTRE
FREDERICKSBURG VA
22407-1123
US

IV. Provider business mailing address

8123 GILROY DR
LORTON VA
22079-2937
US

V. Phone/Fax

Practice location:
  • Phone: 540-786-2272
  • Fax: 540-786-3793
Mailing address:
  • Phone: 443-845-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. MICHAEL G KWOK
Title or Position: PRESIDENT / OPTOMETRIST
Credential: O.D.
Phone: 443-845-1188