MEDICARE: DR. KRISTIE ANH VO 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	11402T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922148634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIE ANH VO O.D

Provider Business Mailing Address
First Line	:	6445 PATS RANCH RD STE D
Second Line	:
City	:	MIRA LOMA
State	:	CA
Zip	:	91752-4439
Country	:	US
Telephone Number	:	951-371-3937
Fax Number	:	951-371-6735

Provider Business Practice Location Address
First Line	:	6445 PATS RANCH RD STE D
Second Line	:
City	:	MIRA LOMA
State	:	CA
Zip	:	91752-4439
Country	:	US
Telephone Number	:	951-371-3937
Fax Number	:	951-371-6735

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	12/21/2017

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