Provider Demographics
NPI:1336491679
Name:GARCIA-BALOK, VANESSA CRYSTAL (OD)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:CRYSTAL
Last Name:GARCIA-BALOK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:CRYSTAL
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5961 S LOS ALTOS PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-2500
Mailing Address - Country:US
Mailing Address - Phone:775-359-2020
Mailing Address - Fax:775-359-2676
Practice Address - Street 1:608 S PALESTINE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751
Practice Address - Country:US
Practice Address - Phone:903-675-6440
Practice Address - Fax:903-675-6676
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist