Provider Demographics
NPI:1699845537
Name:VARGAS, CHRISTOPHER EDWIN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:EDWIN
Last Name:VARGAS
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 1:947 S ANAHEIM BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5591
Mailing Address - Country:US
Mailing Address - Phone:714-491-0881
Mailing Address - Fax:
Practice Address - Street 1:947 S ANAHEIM BLVD STE 230
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5591
Practice Address - Country:US
Practice Address - Phone:714-491-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11770T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0117700Medicaid
CAU89045Medicare UPIN
CASD0117700Medicaid