MEDICARE: DR. KEVIN LADINES VILLARAMA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	34510	CA

General Provider Information

NPI Number	:	1831713791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN LADINES VILLARAMA OD

Provider Business Mailing Address
First Line	:	2016 E MUNCIE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-0405
Country	:	US
Telephone Number	:	559-824-4024
Fax Number	:

Provider Business Practice Location Address
First Line	:	5478 N PALM AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-1940
Country	:	US
Telephone Number	:	559-447-4990
Fax Number	:	559-447-4994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2020
Last Update Date	:	11/14/2020

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