Provider Demographics
NPI:1447932876
Name:VARGAS, CARLOS ALBERTO
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALBERTO
Last Name:VARGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14099 ASHER VW
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5313
Mailing Address - Country:US
Mailing Address - Phone:571-356-2975
Mailing Address - Fax:
Practice Address - Street 1:14099 ASHER VW
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5313
Practice Address - Country:US
Practice Address - Phone:571-356-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
VA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician