Healthcare Provider Details

I. General information

NPI: 1891965851
Provider Name (Legal Business Name): PHILIP W VALENTINE OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 SPRUCE AVE
SIDNEY OH
45365-3360
US

IV. Provider business mailing address

739 SPRUCE AVE PO BOX 179
SIDNEY OH
45365-3360
US

V. Phone/Fax

Practice location:
  • Phone: 937-492-1990
  • Fax: 937-492-7230
Mailing address:
  • Phone: 937-492-1990
  • Fax: 937-492-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOH2815
License Number StateOH

VIII. Authorized Official

Name: DR. PHILIP W VALENTINE
Title or Position: OWNER
Credential: OD
Phone: 937-492-1990