=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013260066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NIKO OLAVI VAHAMAKI O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2012
-----------------------------------------------------
Last Update Date | 12/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3298 MAIN ST
-----------------------------------------------------
City | EXMORE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-442-5079
-----------------------------------------------------
Fax | 757-442-4685
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 561
-----------------------------------------------------
City | EXMORE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23350-0561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-442-5079
-----------------------------------------------------
Fax | 757-442-4685
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 14551
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------