Healthcare Provider Details

I. General information

NPI: 1174782973
Provider Name (Legal Business Name): VALLEY EYE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5116 HEATH RD
AUBURN AL
36830-4201
US

IV. Provider business mailing address

5116 HEATH RD
AUBURN AL
36830-4201
US

V. Phone/Fax

Practice location:
  • Phone: 334-468-0698
  • Fax: 334-502-1453
Mailing address:
  • Phone: 334-468-0698
  • Fax: 334-502-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-B57-TA-770
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberS-B57-TA-770
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberS-B57-TA-770
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberS-B57-TA-770
License Number StateAL

VIII. Authorized Official

Name: DR. DANIEL J. EAGAN JR.
Title or Position: MEMBER
Credential: O.D.
Phone: 334-468-0698