Healthcare Provider Details

I. General information

NPI: 1720075310
Provider Name (Legal Business Name): STEVEN VALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MEADOW AVE
SCRANTON PA
18505-2337
US

IV. Provider business mailing address

RURAL ROUTE #5 510 HIGHLAND AVENUE
CLARKS SUMMIT PA
18411-9079
US

V. Phone/Fax

Practice location:
  • Phone: 570-504-1530
  • Fax: 570-504-1533
Mailing address:
  • Phone: 570-587-1960
  • Fax: 570-586-3937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD041945-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: