Healthcare Provider Details

I. General information

NPI: 1336491679
Provider Name (Legal Business Name): VANESSA CRYSTAL GARCIA-BALOK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA CRYSTAL GARCIA O.D.

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/03/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 S PALESTINE
ATHENS TX
75751
US

IV. Provider business mailing address

5961 S LOS ALTOS PKWY STE 101
SPARKS NV
89436-2500
US

V. Phone/Fax

Practice location:
  • Phone: 903-675-6440
  • Fax: 903-675-6676
Mailing address:
  • Phone: 775-359-2020
  • Fax: 775-359-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number825
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: