MEDICARE: AVON WAI KWONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9376TPL	CA

General Provider Information

NPI Number	:	1114286242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVON WAI KWONG

Provider Business Mailing Address
First Line	:	611 BROADWAY
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-4405
Country	:	US
Telephone Number	:	415-982-0388
Fax Number	:	415-217-7010

Provider Business Practice Location Address
First Line	:	611 BROADWAY
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-4405
Country	:	US
Telephone Number	:	415-982-0388
Fax Number	:	415-217-7010

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. AVON WAI KWONG
Credential	:	O.D.
Telephone Number	:	415-982-0388

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	05/09/2012

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