Healthcare Provider Details

I. General information

NPI: 1225190093
Provider Name (Legal Business Name): DAVID KUO OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 N PARHAM RD SUITE N02
RICHMOND VA
23229-5533
US

IV. Provider business mailing address

2013 FLOYD AVE APT 2
RICHMOND VA
23220-4544
US

V. Phone/Fax

Practice location:
  • Phone: 804-740-4372
  • Fax:
Mailing address:
  • Phone: 804-651-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001522
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: