Healthcare Provider Details

I. General information

NPI: 1336068048
Provider Name (Legal Business Name): VALDEZ EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CHENEGA AVE STE C
VALDEZ AK
99686-0045
US

IV. Provider business mailing address

668 STEELE CREEK RD
FAIRBANKS AK
99712-2701
US

V. Phone/Fax

Practice location:
  • Phone: 973-640-0161
  • Fax:
Mailing address:
  • Phone: 973-640-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JAMIE VARGHESE
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 973-640-0161