Healthcare Provider Details

I. General information

NPI: 1033145180
Provider Name (Legal Business Name): VALLEY EYE INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 FAIRINGTON DR
SIDNEY OH
45365-8913
US

IV. Provider business mailing address

1118 FAIRINGTON DR
SIDNEY OH
45365-8913
US

V. Phone/Fax

Practice location:
  • Phone: 937-492-3755
  • Fax: 937-492-1132
Mailing address:
  • Phone: 937-492-3755
  • Fax: 937-492-1132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number3380
License Number StateOH

VIII. Authorized Official

Name: DR. MICHAEL LEE STARK
Title or Position: OWNER
Credential:
Phone: 937-492-3755