Healthcare Provider Details

I. General information

NPI: 1861906935
Provider Name (Legal Business Name): KWOK FAMILY EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 TYSONS CORNER CTR
MC LEAN VA
22102-4525
US

IV. Provider business mailing address

8025 TYSONS CORNER CTR
MC LEAN VA
22102-4525
US

V. Phone/Fax

Practice location:
  • Phone: 703-734-0977
  • Fax:
Mailing address:
  • Phone: 703-734-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHAEL G KWOK
Title or Position: OWNER
Credential: OD
Phone: 443-845-1188