Healthcare Provider Details

I. General information

NPI: 1013260066
Provider Name (Legal Business Name): NIKO OLAVI VAHAMAKI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 12/23/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3298 MAIN ST
EXMORE VA
23350
US

IV. Provider business mailing address

PO BOX 561
EXMORE VA
23350-0561
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-5079
  • Fax: 757-442-4685
Mailing address:
  • Phone: 757-442-5079
  • Fax: 757-442-4685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: