Healthcare Provider Details

I. General information

NPI: 1215380530
Provider Name (Legal Business Name): VALLEY VISION EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 N MOAPA VALLEY BLVD
OVERTON NV
89040
US

IV. Provider business mailing address

1170 N MOAPA VALLEY BLVD
OVERTON NV
89040
US

V. Phone/Fax

Practice location:
  • Phone: 702-397-2020
  • Fax:
Mailing address:
  • Phone: 702-397-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9043-T
License Number StateTX

VIII. Authorized Official

Name: JEFF FOSTER
Title or Position: OPTOMETRIST
Credential: OD
Phone: 702-397-2020