Organization
JONATHAN N. VALAMIDES, O.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN NICHOLAS VALAMIDES OD (PRESIDENT)
(817) 874-7201
Entity
Organization
Contact information
Practice address
7604 DENTON HWY STE 208, WATAUGA, TX 76148-2477
(817) 503-7997
Mailing address
5107 ANDALUSIA TRL, ARLINGTON, TX 76017-3131
(817) 874-7201
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7079TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790984789
NATIONAL PROVIDER ID TYPE 1
—
Enumeration date
04/19/2018
Last updated
04/19/2018
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