MEDICARE: DR. KRISTAL C KAWAMOTO O.D.

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	13522	CA

General Provider Information

NPI Number	:	1730335845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTAL C KAWAMOTO O.D.

Provider Business Mailing Address
First Line	:	20547 PESARO WAY
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-4149
Country	:	US
Telephone Number	:	818-642-3803
Fax Number	:

Provider Business Practice Location Address
First Line	:	19636 SHERMAN WAY
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-3647
Country	:	US
Telephone Number	:	818-774-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	06/09/2026

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