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General NPI Number Information
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NPI Number | 1841592052
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Entity Type | Organization
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Legal Business Name | JOE A VARGAS O D PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 789 S DORA ST
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City | UKIAH
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State | CA
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Zip | 95482-5335
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Country | US
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Telephone | 707-462-8363
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Fax | 707-462-8366
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Provider Business Mailing Address
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Address Line | 789 S DORA ST
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City | UKIAH
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State | CA
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Zip | 95482-5335
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Country | US
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Telephone | 707-462-8363
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Fax | 707-462-8366
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOE A. VARGAS
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Credential | O.D.
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Telephone | 707-462-8363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10744T
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License Number State | CA
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