Healthcare Provider Details

I. General information

NPI: 1780797613
Provider Name (Legal Business Name): VALLEY EYE CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E NORTHERN AVE STE B
PHOENIX AZ
85020-4188
US

IV. Provider business mailing address

1241 E NORTHERN AVE
PHOENIX AZ
85020-4277
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-6888
  • Fax: 602-242-4654
Mailing address:
  • Phone: 602-242-6888
  • Fax: 602-242-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1522
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number1522
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number1522
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1522
License Number StateAZ

VIII. Authorized Official

Name: DR. LINDSEY M CLYDE
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 602-242-6888