Healthcare Provider Details

I. General information

NPI: 1457176109
Provider Name (Legal Business Name): CRISTIAN CHAIRES VAZQUEZ OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 JENSEN AVE
SANGER CA
93657-2413
US

IV. Provider business mailing address

595 BIGGER ST APT 109
PARLIER CA
93648-2585
US

V. Phone/Fax

Practice location:
  • Phone: 559-875-4515
  • Fax:
Mailing address:
  • Phone: 559-652-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: