Healthcare Provider Details

I. General information

NPI: 1396059549
Provider Name (Legal Business Name): VALLEY EYE CLINIC & OPTICAL P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 3RD ST
WASHINGTON MO
63090-3010
US

IV. Provider business mailing address

1431 BEAM AVE
MAPLEWOOD MN
55109-1064
US

V. Phone/Fax

Practice location:
  • Phone: 636-390-3999
  • Fax: 636-390-3959
Mailing address:
  • Phone: 612-486-1749
  • Fax: 612-486-1750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2776
License Number StateMN

VIII. Authorized Official

Name: DAVID H HESS
Title or Position: OWNER
Credential: OD
Phone: 612-486-1749