Provider Demographics
NPI:1477276905
Name:VARGAS TORRECILLA, KARINA (OD)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:VARGAS TORRECILLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 W NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-1103
Mailing Address - Country:US
Mailing Address - Phone:623-877-3571
Mailing Address - Fax:
Practice Address - Street 1:9350 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-1103
Practice Address - Country:US
Practice Address - Phone:623-877-3571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2597152W00000X
AZOPT-002597152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist