Healthcare Provider Details

I. General information

NPI: 1184798936
Provider Name (Legal Business Name): NORTH VALLEY EYE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 INDIAN HILLS RD SUITE 341
MISSION HILLS CA
91345-1200
US

IV. Provider business mailing address

11550 INDIAN HILLS RD SUITE 341
MISSION HILLS CA
91345-1200
US

V. Phone/Fax

Practice location:
  • Phone: 818-365-0606
  • Fax: 818-898-0205
Mailing address:
  • Phone: 818-365-0606
  • Fax: 818-898-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. ELISE LEVINE
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-365-0606