Healthcare Provider Details

I. General information

NPI: 1306400478
Provider Name (Legal Business Name): VALENTINE EYE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 ERDMAN WAY # 205
LEOMINSTER MA
01453-1840
US

IV. Provider business mailing address

80 ERDMAN WAY # 205
LEOMINSTER MA
01453-1840
US

V. Phone/Fax

Practice location:
  • Phone: 978-696-5674
  • Fax: 978-400-7836
Mailing address:
  • Phone: 978-696-5674
  • Fax: 867-400-7836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HENRY RICHARD VALENTINE
Title or Position: OWNER
Credential: OD
Phone: 978-502-9434