Provider Demographics
NPI:1689161176
Name:JONATHAN N. VALAMIDES, O.D., P.A.
Entity Type:Organization
Organization Name:JONATHAN N. VALAMIDES, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:VALAMIDES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-874-7201
Mailing Address - Street 1:5107 ANDALUSIA TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-3131
Mailing Address - Country:US
Mailing Address - Phone:817-874-7201
Mailing Address - Fax:
Practice Address - Street 1:7604 DENTON HWY STE 208
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2477
Practice Address - Country:US
Practice Address - Phone:817-503-7997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7079TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790984789OtherNATIONAL PROVIDER ID TYPE 1