Provider Demographics
NPI:1134154800
Name:VALLIN, KARRIN MICHELLE (OD)
Entity type:Individual
Prefix:DR
First Name:KARRIN
Middle Name:MICHELLE
Last Name:VALLIN
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 1:4633 WHITNEY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-4100
Mailing Address - Country:US
Mailing Address - Phone:916-487-1717
Mailing Address - Fax:916-487-3081
Practice Address - Street 1:4633 WHITNEY AVE STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4100
Practice Address - Country:US
Practice Address - Phone:916-487-1717
Practice Address - Fax:916-487-3081
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10470T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0104700Medicaid
FW159ZMedicare PIN
CAU69272Medicare UPIN
CASD0104701Medicare PIN
CASD0104700Medicaid
CA5845400001Medicare NSC