Healthcare Provider Details

I. General information

NPI: 1629590039
Provider Name (Legal Business Name): ASHLEY SARAH VARGHESE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 NOBEL DR STE 130
SAN DIEGO CA
92122-1004
US

IV. Provider business mailing address

3895 MIDWAY DR APT 103
SAN DIEGO CA
92110-5230
US

V. Phone/Fax

Practice location:
  • Phone: 858-283-5371
  • Fax: 858-588-6555
Mailing address:
  • Phone: 214-335-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9271T
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: