Healthcare Provider Details

I. General information

NPI: 1164316469
Provider Name (Legal Business Name): KRISTEN VALLES OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E NEW HAVEN AVE
MELBOURNE FL
32901-5427
US

IV. Provider business mailing address

502 E NEW HAVEN AVE
MELBOURNE FL
32901-5427
US

V. Phone/Fax

Practice location:
  • Phone: 321-727-2020
  • Fax: 321-726-4074
Mailing address:
  • Phone: 321-727-2020
  • Fax: 321-726-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: