MEDICARE: KRISTIE VO O.D, INC

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	11402T	CA

General Provider Information

NPI Number	:	1235309667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTIE VO O.D, INC

Provider Business Mailing Address
First Line	:	27867 CRESCENT CT
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92555-5738
Country	:	US
Telephone Number	:	714-334-5237
Fax Number	:	909-355-8500

Provider Business Practice Location Address
First Line	:	6445 PATS RANCH RD
Second Line	:	SUITE D
City	:	MIRA LOMA
State	:	CA
Zip	:	91752-4439
Country	:	US
Telephone Number	:	714-334-5237
Fax Number	:	909-355-8500

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KRISTIE A VO
Credential	:	OD
Telephone Number	:	714-334-5237

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	02/29/2008

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