Provider Demographics
NPI:1831713791
Name:VILLARAMA, KEVIN LADINES (OD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LADINES
Last Name:VILLARAMA
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 1:2016 E MUNCIE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0405
Mailing Address - Country:US
Mailing Address - Phone:559-824-4024
Mailing Address - Fax:
Practice Address - Street 1:5478 N PALM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1940
Practice Address - Country:US
Practice Address - Phone:559-447-4990
Practice Address - Fax:559-447-4994
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist