Provider Demographics
NPI:1619541315
Name:VALLIERE, CHRISTOPHER RYAN (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RYAN
Last Name:VALLIERE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E 4115 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2535
Mailing Address - Country:US
Mailing Address - Phone:940-727-9947
Mailing Address - Fax:
Practice Address - Street 1:313 E 4115 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2535
Practice Address - Country:US
Practice Address - Phone:801-484-2020
Practice Address - Fax:801-466-2865
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12322415-9934152W00000X, 152W00000X
TX10251T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist