Healthcare Provider Details

I. General information

NPI: 1164604393
Provider Name (Legal Business Name): VALLEY OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9011 W SAHARA AVE SUITE 101
LAS VEGAS NV
89117-4800
US

IV. Provider business mailing address

9011 W SAHARA AVE SUITE 101
LAS VEGAS NV
89117-4800
US

V. Phone/Fax

Practice location:
  • Phone: 702-794-2020
  • Fax: 702-732-4108
Mailing address:
  • Phone: 702-794-2020
  • Fax: 702-732-4108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MELISSA A BEATY
Title or Position: OWNER
Credential: O.D.
Phone: 702-794-2020